title: Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia.
abstract: OBJECTIVE
  Infants with biliary atresia undergoing living donor liver transplantation (LDLT) are at increased risk of portal vein (PV) complications because of their smaller vascular caliber and sclerosis because of previous Kasai portoenterostomy and recurrent cholangitis.
  
  
  METHODS
  Of 154 children who underwent transplantation between November 2005 and January 2011, 34 with biliary atresia received a transplant while younger than 1 year. Six patients underwent PV reconstruction with an interposition vein graft, and the others underwent the branch patch technique. The clinical characteristics of those who underwent the interposition reconstruction or the branch patch technique were compared, and the PV complications were assessed.
  
  
  RESULTS
  Portal vein complications occurred in 5 patients (14.7%) in the branch patch group. There were 4 patient deaths, and all of them had received branch patch reconstruction. The branch patch reconstruction cases with a sclerotic small caliber (<4 mm) determined by using preoperative ultrasonography showed a significantly high mortality rate (44.4%). All patients with interposition vein graft reconstruction are still alive with excellent graft function without anticoagulation therapy.
  
  
  CONCLUSIONS
  The interposition vein graft appears to be a feasible option with better graft survival and less PV complications when performing LDLT for biliary atresia in infants younger than 1.
authors.affiliation: Department of Transplantation, National Center for Child Health and Development, Tokyo 157-8535, Japan. kagoshimakurobuta@hotmail.com
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Akinari
authors.initials: A
authors.lastname: Fukuda
authors.forename: Takanobu
authors.initials: T
authors.lastname: Shigeta
authors.forename: Dale L
authors.initials: DL
authors.lastname: Loh
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kakiuchi
authors.forename: Chiaki
authors.initials: C
authors.lastname: Karaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Miyazaki
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Nosaka
authors.forename: Atsuko
authors.initials: A
authors.lastname: Nakazawa
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
mesh_terms: D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008642:Mesenteric Veins / Q000637:transplantation; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D058017:Vascular Grafting