Korean J Transplant.  2019 Dec;33(4):106-111. 10.4285/jkstn.2019.33.4.106.

Long-term results of conjoined unification venoplasty for multiple portal vein branches of the right liver graft in living donor liver transplantations

Affiliations
  • 1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
  • 2Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Abstract

BACKGROUND
Autologous portal vein Y-graft (PYG) interposition has been the standard procedure for reconstruction of double portal vein (PV) orifices of right liver grafts during living donor liver transplantations. However, it has the disadvantage of being vulnerable to anastomotic stenosis. A refined technique of conjoined unification venoplasty (CUV) was developed to secure PV reconstruction.
METHODS
We reviewed the surgical outcomes in PV reconstructions using CUVs in 21 cases which were followed up for >3 years.
RESULTS
The mean age of recipients was 51.7±4.9 years. The model for end-stage liver disease score was 15.3±6.4. The graft-recipient weight ratio was 1.12±0.21. Recipient PYGs were harvested in all cases. All living donors were blood relatives or relatives through marriage with type III PV anomalies. The number of right liver graft PV orifices was two in 19 cases and three in two cases. For the central intervening vein patch, a PV segment was used in six cases, and an autologous greater saphenous vein patch was used in the remaining 15 cases. The 21 patient cohort displayed a 100% 4-year patient survival rate. None of them underwent any PV interventions including interventional stenting. Serial follow-up computed tomography scans revealed that the reconstructed PV showed early reshaping with a stable streamlined configuration for over 3 years.
CONCLUSIONS
PV reconstruction using the CUV technique appears to be significantly more effective in preventing PV complications. We believe that CUV is a useful technique to reconstruct right liver grafts with multiple PV orifices.

Keyword

Living donor liver transplantation; Y-graft; Portal vein anomaly; Anastomotic stenosis

MeSH Terms

Cohort Studies
Constriction, Pathologic
Follow-Up Studies
Humans
Liver Diseases
Liver Transplantation*
Liver*
Living Donors*
Marriage
Portal Vein*
Saphenous Vein
Stents
Survival Rate
Transplants*
Veins
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