title: Which is the best technique for hepatic venous reconstruction in pediatric living-donor liver transplantation? Experience from a single center.
abstract: OBJECTIVE
  The introduction of the piggyback technique for reconstruction of the liver outflow in reduced-size liver transplants for pediatric patients has increased the incidence of hepatic venous outflow block (HVOB). Here, we proposed a new technique for hepatic venous reconstruction in pediatric living-donor liver transplantation.
  
  
  METHODS
  Three techniques were used: direct anastomosis of the orifice of the donor hepatic veins and the orifice of the recipient hepatic veins (group 1); triangular anastomosis after creating a wide triangular orifice in the recipient inferior vena cava at the confluence of all the hepatic veins (group 2); and a new technique, which is a wide longitudinal anastomosis performed at the anterior wall of the inferior vena cava (group 3).
  
  
  RESULTS
  In groups 1 and 2, the incidences of HVOB were 27.7% and 5.7%, respectively. In group 3, no patient presented HVOB (P = .001). No difference was noted between groups 2 and 3.
  
  
  CONCLUSIONS
  Hepatic venous reconstruction in pediatric living-donor liver transplantation must be preferentially performed by using a wide longitudinal incision at the anterior wall of the recipient inferior vena cava. As an alternative technique, triangulation of the recipient inferior vena cava, including the orifices of the 3 hepatic veins, may be used.
authors.affiliation: Pediatric Surgery Division and Liver Transplantation Unit, Children's Institute, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil. uenist@usp.br
authors.forename: Uenis
authors.initials: U
authors.lastname: Tannuri
authors.forename: Maria M
authors.initials: MM
authors.lastname: Santos
authors.forename: Ana Cristina A
authors.initials: AC
authors.lastname: Tannuri
authors.forename: Nelson E
authors.initials: NE
authors.lastname: Gibelli
authors.forename: Airton
authors.initials: A
authors.lastname: Moreira
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Carnevale
authors.forename: Ali A
authors.initials: AA
authors.lastname: Ayoub
authors.forename: João G
authors.initials: JG
authors.lastname: Maksoud-Filho
authors.forename: Wagner C
authors.initials: WC
authors.lastname: Andrade
authors.forename: Manoel C P
authors.initials: MC
authors.lastname: Velhote
authors.forename: Marcos M
authors.initials: MM
authors.lastname: Silva
authors.forename: Maria L
authors.initials: ML
authors.lastname: Pinho-Apezzato
authors.forename: Helena T
authors.initials: HT
authors.lastname: Miyatani
authors.forename: Raimundo R N
authors.initials: RR
authors.lastname: Guimarães
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000601:surgery*; D006504:Hepatic Veno-Occlusive Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*; D055815:Young Adult