Portal vein reconstruction using vein grafts in pediatric living donor liver transplantation: Current status
Tarek Abdelazeem Sabra
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Department of General Surgery, Graduate School of Medicine, Assiut University, Assiut, Egypt
Search for more papers by this authorCorresponding Author
Hideaki Okajima
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Correspondence
Hideaki Okajima, MD, Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Email: [email protected]
Search for more papers by this authorAtsushi Yoshizawa
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorTatsuya Okamoto
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorTakayuki Anazawa
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorShintaro Ygi
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorKoichiro Hata
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorKentaro Yasuchika
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorKojiro Taura
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorEtsuro Hatano
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorToshimi Kaido
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorShinji Uemoto
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorTarek Abdelazeem Sabra
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Department of General Surgery, Graduate School of Medicine, Assiut University, Assiut, Egypt
Search for more papers by this authorCorresponding Author
Hideaki Okajima
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Correspondence
Hideaki Okajima, MD, Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Email: [email protected]
Search for more papers by this authorAtsushi Yoshizawa
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorTatsuya Okamoto
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorTakayuki Anazawa
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorShintaro Ygi
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorKoichiro Hata
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorKentaro Yasuchika
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorKojiro Taura
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorEtsuro Hatano
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorToshimi Kaido
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorShinji Uemoto
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Search for more papers by this authorAbstract
PV reconstruction is an important aspect of LDLT, with post-transplant outcomes depending on PV reconstruction methods. However, it is unclear whether the preferential selection of these techniques is dependent on preoperative recipient characteristics. This retrospective study assessed whether preoperative recipient factors differed in pediatric patients who did and did not receive VGs for PV reconstruction. Of 113 pediatric patients who underwent LDLT from January 2010 to July 2015, 31 (27%) underwent PV reconstruction with VGs and the other 82 (73%) without VGs. The presence of collateral vessels (P<.0001) and ascites (P=.02); PV size (P<.001), thrombosis (P=.01) and the direction of flow (P=.01), Child-Pugh class A vs B/C liver function (P=.01), Alb concentration (P=.02), primary diagnosis: BA vs non-BA (P=.03), and previous abdominal surgery (P<.005) differed significantly in patients who did and did not receive VGs for PV reconstruction. PV complications, patient survival, and graft survival did not differ significantly in patients with and without VGs at 1-year follow-up. VGs should be harvested for recipients with pretransplant hypoplastic PV, intense collaterals, hepatofugal flow, poor liver status, or previous abdominal surgery.
References
- 1Alvarez F. Portal vein complications after pediatric liver transplantation. Curr Gastroenterol Rep. 2012; 14: 270–274.
- 2Saad S, Tanaka K, Inomata Y, et al. Portal vein reconstruction in pediatric liver transplantation from living donors. Ann Surg. 1998; 227: 275–281.
- 3Marwan IK, Fawzy AT, Egawa H, et al. Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation. Surgery. 1999; 125: 265–270.
- 4Millis JM, Seaman DS, Piper JB, et al. Portal vein thrombosis and stenosis in pediatric liver transplantation. Transplantation. 1996; 62: 748–754.
- 5Ueda M, Oike F, Kasahara M, et al. Portal vein complications in pediatric living donor liver transplantation using left-side grafts. Am J Transplant. 2008; 8: 2097–2105.
- 6de Magnée C, Bourdeaux C, De Dobbeleer F, et al. Impact of pre-transplant liver hemodynamics and portal reconstruction techniques on post-transplant portal vein complications in pediatric liver transplantation: a retrospective analysis in 197 recipients. Ann Surg. 2011; 254: 55–61.
- 7Tokunaga Y, Tanaka K, Yamaoka Y, Ozawa K. Portal vein graft in living related hepatic transplantation. J Am Coll Surg. 1994; 178: 297–309.
- 8Broelsch CE, Whitington PF, Emond JC, et al. Liver transplantation in children from living related donors. Surgical techniques and results. Ann Surg. 1991; 214: 428–437; discussion 437–439.
- 9Matsuura T, Yanagi Y, Saeki I, Hayashida M, Taguchi T. Outcome of modified portal vein anastomosis for recipients with portal vein thrombosis or stenosis before living donor liver transplantation. J Pediatr Surg. 2011; 46: 2291–2295.
- 10Neto JS, Fonseca EA, Feier FH, et al. Analysis of factors associated with portal vein thrombosis in pediatric living donor liver transplant recipients. Liver Transpl. 2014; 20: 1157–1167.
- 11Kanazawa H, Sakamoto S, Fukuda A, et al. Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia. J Pediatr Surg. 2012; 47: 523–527.
- 12Buell JF, Funaki B, Cronin DC, et al. Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg. 2002; 236: 658–666.
- 13Cheng YF, Huang TL, Chen CL, et al. Intraoperative Doppler ultrasound in liver transplantation. Clin Transpl. 1998; 12: 292–299.
- 14Yu C-Y, Concejero AM, Huang T-L, et al. Preoperative vascular evaluation in living donor liver transplantation for biliary atresia. Transplant Proc. 2008; 40: 2478–2480.
- 15McDiarmid SV, Anand R, Lindblad AS. Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation. 2002; 74: 173–181.
- 16Tanaka K, Uemoto S, Tokunaga Y, et al. Surgical techniques and innovations in living related liver transplantation. Ann Surg. 1993; 217: 82–91.
- 17Shaw BW, Iwatsuki S, Bron K, Starzl TE. Portal vein grafts in hepatic transplantation. Surg Gynecol Obstet. 1985; 161: 66–68.
- 18Gu L-H, Fang H, Li F-H, Zhang S-J, Han L-Z, Li Q-G. Preoperative hepatic hemodynamics in the prediction of early portal vein thrombosis after liver transplantation in pediatric patients with biliary atresia. Hepatobiliary Pancreat Dis Int. 2015; 14: 380–385.
- 19Schepis F, Cammà C, Niceforo D, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology. 2001; 33: 333–338.
- 20Iwakiri Y, Shah V, Rockey DC. Vascular pathobiology in chronic liver disease and cirrhosis – current status and future directions. J Hepatol. 2014; 61: 912–924.
- 21Mori A, Iida T, Iwasaki J, et al. Portal vein reconstruction in adult living donor liver transplantation for patients with portal vein thrombosis in single center experience. J Hepatobiliary Pancreat Sci. 2015; 22: 467–474.
- 22Hernandez-Cano AM, Geis JR, Rumack CH, Stellin GP, Lilly JR. Portal vein dynamics in biliary atresia. J Pediatr Surg. 1987; 22: 519–521.
- 23Khong PL, Ooi CGC, Saing H, et al. Portal venous velocity in the follow-up of patients with biliary atresia after Kasai portoenterostomy. J Pediatr Surg. 2002; 37: 873–876.
Citing Literature
