title: Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis.
abstract: In total portosplenomesenteric thrombosis patients, cavoportal hemitransposition (CPHT) is indicated but rarely applicable for adult-to-adult (A-to-A) living donor liver transplantation (LDLT) because partial liver graft requires splanchno-portal inflow for liver graft regeneration. If intra- & peri-pancreatic collaterals draining into pericholedochal varix were present, pericholedochal varix may provide splanchnic blood flow to the transplanted liver and also relieve recipient's portal hypertension. To date, however, there is no successful report using pericholedochal varix in liver transplantation (LT). We successfully performed A-to-A LDLTs using pericholedochal varix for those 2 patients. The surgical strategies are followings: (a) dissection of hepatic hilum to isolate left hepatic artery using for arterial reconstruction of implanted right lobe graft, (b) en-mass clamping of the undissected remaining hilum if we can leave adequate length of stump from the clamping site, and then hilum is divided, (c) delay the donor hepatectomy until the feasibility of the recipient operation is confirmed. Portal flow was established between the sizable pericholedochal varix (caliber > 1cm) and graft portal vein, but the individually designed approaches were used for each patients. Currently, they have been enjoying normal life on posttransplant 92 and 44 months respectively. In conclusion, enlarged pericholedochal varix in patients with totally obliterated splanchnic veins might be an useful inflow to restore portal flow and secure good outcome in A-to-A LDLT. AASLD.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Jung-Man
authors.initials: JM
authors.lastname: Namkoong
authors.forename: Hyung-Woo
authors.initials: HW
authors.lastname: Park
authors.forename: Yo-Han
authors.initials: YH
authors.lastname: Park
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications; D006439:Hemodynamics; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000601:surgery; D017093:Liver Failure / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology* / Q000601:surgery; D013154:Spleen / Q000503:physiopathology*; D013927:Thrombosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014648:Varicose Veins / Q000503:physiopathology* / Q000601:surgery