End-to-side portocaval shunting for a small-for-size graft in living donor liver transplantation.
In the development of adult-to-adult living donor liver transplantation (LDLT), the small-for-size graft has been associated with poor clinical outcome. Persistent portal hypertension or portal venous overperfusion are considered to be causative factors, and partial diversion of portal flow to systemic circulation may be effective for avoiding injuries that occur in the small-for-size (SFS) graft. Recently, we constructed an end-to-side portocaval shunting using 1 of the portal branches and anastomosed the other branch with the portal vein of the graft in 2 cases of LDLT recipients transplanted with a SFS graft. With the suppression of portal hypertension, as well as sufficient portal flow to the graft, the recipients recovered successfully with favorable graft function. This new and simple technique may be able to be used as a feasible and effective method to attenuate the SFS syndrome.
Takada
Yasutsugu
Y
Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan. takaday@kuhp.kyoto-u.ac.jp
Ueda
Mikiko
M
Ishikawa
Yukika
Y
Fujimoto
Yasuhiro
Y
Miyauchi
Hideaki
H
Ogura
Yasuhiro
Y
Ochiai
Takenori
T
Tanaka
Koichi
K
D000293:Adolescent; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D016896:Treatment Outcome