title: Reconstruction of Anomalous Portal Venous Branching in Right Lobe Living Donor Liver Transplantation: Malatya Approach.
abstract: Reconstruction of anomalous portal vein branching (APVB) during right lobe living donor liver transplantation (LDLT) can be challenging. The goal of this article is to describe our surgical technique, named the Malatya Approach, in case of APVB during right lobe LDLT. The technique unifies the APVB and obtains a funnel-shaped common extension with a circumferential fence by a saphenous vein conduit. In total, 126 (10.6%) of 1192 right lobe grafts had APVB that were divided into 2 groups according to the adopted surgical techniques: the Malatya Approach group (n = 91) and the previously defined other techniques group (n = 35). Both groups were compared regarding portal vein thrombosis (PVT), postoperative 90-day mortality and survival. PVT developed in 3 patients (3.3%) in the Malatya Approach group and developed in 10 (28.6%) patients for the other group (P < 0.001). There were 8 (8.8%) 90-day mortalities in the Malatya Approach group (1 PVT related) and 15 patients (9 PVT related) died in the other techniques group (P < 0.001). Mean follow-up time for both groups was similar (999.1 days for the Malatya Approach group versus 1024.7 days for the other group; P = 0.47), but longterm survival in the Malatya Approach group was better than in the other group (84.6% versus 40%; P < 0.001). Multivariate analysis revealed that the Malatya Approach group showed less PVT development and longer survival (P < 0.001). This technique is promising to avoid PVT and mortalities in cases of APVB during right lobe LDLT. Liver Transplantation 23 751-761 2017 AASLD.
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Sezai
authors.initials: S
authors.lastname: Yilmaz
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Isik
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Veysel
authors.identifier: 0000-0002-1510-0288
authors.initials: V
authors.lastname: Ersan
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Emrah
authors.initials: E
authors.lastname: Otan
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Sami
authors.initials: S
authors.lastname: Akbulut
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Abuzer
authors.initials: A
authors.lastname: Dirican
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Kutlu
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Aysegul Sagir
authors.initials: AS
authors.lastname: Kahraman
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Ara
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yilmaz
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Unal
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Aydin
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Turgut
authors.initials: T
authors.lastname: Piskin
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Dincer
authors.initials: D
authors.lastname: Ozgor
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ates
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Ozdemir
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Ince
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Koc
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Adil
authors.initials: A
authors.lastname: Baskiran
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Sait Murat
authors.initials: SM
authors.lastname: Dogan
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Bora
authors.initials: B
authors.lastname: Barut
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Sumer
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Karakas
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Koray
authors.initials: K
authors.lastname: Kutluturk
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Saim
authors.initials: S
authors.lastname: Yologlu
authors.affiliation: Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: Harika
authors.initials: H
authors.lastname: Gozukara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000002:abnormalities* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult