Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia.

Abstract

BACKGROUND/PURPOSE:

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.

METHOD:

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.

CONCLUSION:

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: Hiroyuki Kanazawa, Seisuke Sakamoto, Akinari Fukuda, Takanobu Shigeta, Dale L Loh, Toshihiko Kakiuchi, Chiaki Karaki, Osamu Miyazaki, Syunsuke Nosaka, Atsuko Nakazawa, Mureo Kasahara
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 47 Issue 3 Pg. 523-7 (Mar 2012) ISSN: 1531-5037 [Electronic] United States
• PMID: 22424348 (Publication Type: Comparative Study, Evaluation Study, Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Topics

• Biliary Atresia (mortality, surgery)
• Female
• Follow-Up Studies
• Humans
• Infant
• Kaplan-Meier Estimate
• Liver Transplantation (methods, mortality)
• Living Donors
• Male
• Mesenteric Veins (transplantation)
• Portal Vein (pathology, surgery)
• Postoperative Complications (epidemiology)
• Treatment Outcome
• Vascular Grafting