title: Long-term outcomes of portal Y-graft interposition for anomalous right portal veins in living donor liver transplantation.
abstract: BACKGROUND
  Anomalous portal vein (PV) branching in living donor livers is not uncommon and usually leads to double PV orifices of the right lobe grafts. We have assessed the long-term outcomes of portal Y-graft interposition for adult living donor liver transplantation (LDLT).
  
  
  METHODS
  We retrospectively assessed the outcomes of 79 right-lobe LDLTs using portal Y-graft interposition among the 2001 adult LDLTs performed at our institution from January 2002 to December 2010.
  
  
  RESULTS
  Donor PV types were type III except for one case of type II. Sources of Y-grafts were recipient autologous PV in 76 LDLTs, fresh iliac vein allografts in two, and patch plasty using recipient greater saphenous vein in one. Detailed procedures included a portal Y-graft resection with Y-limbs, corner stay sutures, tying of suture materials under direct mechanical dilatation, and direct edge-to-edge anastomosis to the recipient remnant main PV. Early PV stenting was necessary in five patients (6.3%) due to stenosis or buckling deformity. During a mean follow-up of 42 months, all PVs remained patent until patient death or censoring. Overall 1-, 3-, and 5-year patient survival rates were 93.6%, 88.3%, and 85.5%, respectively. None of the 79 donors experienced major complications requiring reoperation or therapeutic intervention.
  
  
  CONCLUSIONS
  Due to their technical feasibility and excellent long-term outcome, portal Y-graft interposition should be considered a standard procedure for reconstruction of right-lobe grafts with double PV orifices.
authors.affiliation: Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: C-S
authors.initials: CS
authors.lastname: Ahn
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.forename: D-B
authors.initials: DB
authors.lastname: Moon
authors.forename: T-Y
authors.initials: TY
authors.lastname: Ha
authors.forename: G-W
authors.initials: GW
authors.lastname: Song
authors.forename: D-H
authors.initials: DH
authors.lastname: Jung
authors.forename: G-C
authors.initials: GC
authors.lastname: Park
authors.forename: J-M
authors.initials: JM
authors.lastname: Namgoong
authors.forename: S-Y
authors.initials: SY
authors.lastname: Yoon
authors.forename: S-W
authors.initials: SW
authors.lastname: Jung
authors.forename: H-W
authors.initials: HW
authors.lastname: Park
authors.forename: C-S
authors.initials: CS
authors.lastname: Park
authors.forename: Y-H
authors.initials: YH
authors.lastname: Park
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D006085:Graft Survival; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000002:abnormalities / Q000601:surgery*; D056910:Republic of Korea; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D013536:Suture Techniques; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000401:mortality