The Selection of an Interposition Graft for Portal Vein Reconstruction: Maximizing the Availability of Autologous Vessels.
Portal vein (PV) reconstruction is a crucial step in pediatric liver transplantation (LT). Pediatric recipients with a hypoplastic or sclerotic PV often require an interposition vein graft. Allogeneic grafts from donors are generally preferred. However, if they are not available, the use of autologous vessels is necessary.
An 8-month-old girl with biliary atresia (BA) underwent living donor LT with a left lateral segment graft. During the operation, portal vein thrombosis (PVT) developed after direct anastomosis between the recipient PV and graft left PV. We used several techniques to resolve this problem, including ligation of collateral circulation and use of interposition grafts from the left internal jugular vein (IJV) and left renal vein (LRV). On postoperative day 1, PVT reoccurred. Emergency exploratory laparotomy was performed for thrombectomy, using the retrohepatic inferior vena cava (IVC) as an additional vascular graft. The final reconstruction successfully utilized a combination of LRV and IVC grafts between the superior mesenteric vein and graft left PV. Postoperatively, the patient received thrombolytic therapy followed by anticoagulants for thrombus prevention, along with immunosuppressive drugs. The patient's postoperative clinical course was uneventful.
Although the IJV and LRV are established options for PV reconstruction in pediatric LT, we propose retrohepatic IVC as a feasible and effective alternative option. This approach maximizes the availability of autologous vessels; however, selection must be individualized based on graft availability and the patient condition.
An 8-month-old girl with biliary atresia (BA) underwent living donor LT with a left lateral segment graft. During the operation, portal vein thrombosis (PVT) developed after direct anastomosis between the recipient PV and graft left PV. We used several techniques to resolve this problem, including ligation of collateral circulation and use of interposition grafts from the left internal jugular vein (IJV) and left renal vein (LRV). On postoperative day 1, PVT reoccurred. Emergency exploratory laparotomy was performed for thrombectomy, using the retrohepatic inferior vena cava (IVC) as an additional vascular graft. The final reconstruction successfully utilized a combination of LRV and IVC grafts between the superior mesenteric vein and graft left PV. Postoperatively, the patient received thrombolytic therapy followed by anticoagulants for thrombus prevention, along with immunosuppressive drugs. The patient's postoperative clinical course was uneventful.
Although the IJV and LRV are established options for PV reconstruction in pediatric LT, we propose retrohepatic IVC as a feasible and effective alternative option. This approach maximizes the availability of autologous vessels; however, selection must be individualized based on graft availability and the patient condition.
Authors
Kiataramkul Kiataramkul, Sakamoto Sakamoto, Uchida Uchida, Cai Cai, Oshiro Oshiro, Kojima Kojima, Komine Komine, Yanagi Yanagi, Fukuda Fukuda, Kasahara Kasahara
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