title: Outcome of modified portal vein anastomosis for recipients with portal vein thrombosis or stenosis before living donor liver transplantation.
abstract: BACKGROUND
  Portal vein thrombosis (PVT) or stenosis (PVS) often requires challenging techniques for reconstruction in living donor liver transplantation (LDLT).
  
  
  METHODS
  A total of 57 LDLTs were performed between October 1996 and December 2010. There were 16 cases (28%) with PVT/PVS that underwent modified portal vein anastomosis (m-PVa). The m-PVa techniques were classified into 3 groups: patch graft (Type-1), interposition graft (Type-2), and using huge shunt vessels (Type-3). The reconstruction patterns were evaluated with regard to age, graft vessels, PV flow, and complication rate.
  
  
  RESULTS
  The m-PVas were Type-1 in 10 cases, Type-2 in 3 cases, and Type-3 in 3 cases. The vessel graft in Type-1 was the inferior mesenteric vein (IMV) in 8 and the jugular vein in 2 cases, whereas the vessel graft in Type-2 was IMV in 2 and the saphenous vein in 1 case; in Type-3, the vessel grafts were renoportal, gonadal-portal, and coronary-portal anastomoses, respectively. The postoperative PV flow was sufficient in all types and slightly higher in Type-3. The postoperative complications occurred in 20% of the patients who underwent Type-1, in 33% who underwent Type-2, and in 0% who underwent Type-3.
  
  
  CONCLUSIONS
  The m-PVa was effective to overcome the surgical difficulty during transplantation. Pretransplant planning for the selection of the type of reconstruction is important for recipients with PVT/PVS.
authors.affiliation: Department of Pediatric Surgery, Kyushu University, Maidashi, Higashi-ku, Fukuoka, Japan. matsuura@pedsurg.med.kyushu-u.ac.jp
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Matsuura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yanagi
authors.forename: Isamu
authors.initials: I
authors.lastname: Saeki
authors.forename: Makoto
authors.initials: M
authors.lastname: Hayashida
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D003331:Coronary Vessels / Q000601:surgery; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000628:therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy; D007223:Infant; D007601:Jugular Veins / Q000637:transplantation; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008642:Mesenteric Veins / Q000637:transplantation; D011169:Portal Vein / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D015996:Survival Rate; D016042:Transplantation, Heterotopic; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000601:surgery*; D055815:Young Adult