title: Extra-anatomical Meso-portal Venous Jump Graft Repair for Early Portal Vein Thrombosis After Liver Transplant in an Infant With a Hypoplastic Portal Vein: A Case Report.
abstract: OBJECTIVE
  Small infants with biliary atresia and hypoplastic portal veins (PV) are at risk for portal vein thrombosis (PVT) after liver transplantation (LT), which can lead to graft loss and mortality. Extra-anatomical PV reconstruction techniques have been established for adult cases of PVT; however, they have not been widely accepted for infants.
  
  
  METHODS
  Here, we report the successful use of an extra-anatomical meso-portal venous jump graft to treat early PVT after LT in a 6-month-old infant with biliary atresia and PV hypoplasia. At the time of LT, despite a reduced-sized left lateral graft, we had to create a temporary abdominal closure with silastic mesh.
  
  
  RESULTS
  On postoperative day 1, PVT was detected by Doppler ultrasound of the liver. Surgical thrombectomy was attempted. We removed the blood clots and reconstructed the PV using an interposition venous graft. As the PV flow was still not sufficient, we performed an extra-anatomical meso-portal venous jump graft procedure from the recipient superior mesenteric vein to the donor PV. This resulted in a significant improvement in PV flow.
  
  
  CONCLUSIONS
  For small infants at high risk for PVT, a detailed pretransplantation surgical plan and treatment options for possible early PVT are mandatory. An extra-anatomical meso-portal venous jump graft is a viable surgical technique for early PVT in infants.
authors.affiliation: Kyushu Medical Center, Fukuoka, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Matsumoto
authors.affiliation: Atopic Research Center, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: kuchida826@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Uchida
authors.affiliation: Miami Transplant Institute, University of Miami, Miami, Florida, United States.
authors.forename: S
authors.initials: S
authors.lastname: Nishida
authors.affiliation: Transplant Institute, University of Georgetown, Washington, DC, United States.
authors.forename: E R
authors.initials: ER
authors.lastname: Island
authors.affiliation: Miami Transplant Institute, University of Miami, Miami, Florida, United States.
authors.forename: D M
authors.initials: DM
authors.lastname: Levi
authors.affiliation: Miami Transplant Institute, University of Miami, Miami, Florida, United States.
authors.forename: J
authors.initials: J
authors.lastname: Fan
authors.affiliation: Miami Transplant Institute, University of Miami, Miami, Florida, United States.
authors.forename: A
authors.initials: A
authors.lastname: Tekin
authors.affiliation: Miami Transplant Institute, University of Miami, Miami, Florida, United States.
authors.forename: G
authors.initials: G
authors.lastname: Selvaggi
authors.affiliation: Transplant Center, Cleveland Clinic Florida, Weston, Florida, United States.
authors.forename: A G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008642:Mesenteric Veins / Q000637:transplantation*; D011169:Portal Vein / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery*