Improved technique of portal vein reconstruction in pediatric liver transplant recipients with portal vein hypoplasia.
BACKGROUND
Children with small or hypoplastic portal veins represent a challenge for liver transplantation. Graft loss of up to 70% has been reported in these patients in the past. A variety of techniques has been used in both cadaveric and living related transplants in an effort to overcome this problem. Variability arises as to whether to use a vascular graft and where on the portal system to attach the graft.


METHODS
We present our usage of a simple and straightforward interposition iliac vein allograft fashioned in a manner to achieve large anastomotic cross-sectional area on the confluence of the superior mesenteric/splenic veins. The procedure also overcomes problems of graft vein/portal vein size mismatch in the cases where liver and vein grafts are procured from much larger donors.


RESULTS
A total of 14 children presented with hypoplastic portal vein (diameter<5 mm), of a total of 30 consecutive patients requiring cadaveric liver transplants, and benefited from this technique. Median recipient age was 10.5 months. Revascularization times ranged from 22 to 43 min with a mean of 33 min. All patients are alive and well at a mean follow-up of 329 days (10 months). All liver grafts are well and functioning. No portal vein problem was detected.


CONCLUSIONS
Results from this technique are clearly encouraging. Because portal vein hypoplasia is a common problem in pediatric transplant candidates, we believe this alternative technique is of interest and should be added to the transplant surgeon's armamentarium.
Mitchell
Andrew
A
The Liver Unit and Radiology Department, Birmingham Children's Hospital, Steelhouse Lane, B4 6NH and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
John
P R
PR
Mayer
D A
DA
Mirza
D F
DF
Buckels
J A C
JA
De Ville De Goyet
Jean
J
D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*