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Transplantation. 2002 Apr 27;73(8):1244-7.

Improved technique of portal vein reconstruction in pediatric liver transplant recipients with portal vein hypoplasia.

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  • 1The Liver Unit and Radiology Department, Birmingham Children's Hospital, Steelhouse Lane, B4 6NH and Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.

Abstract

BACKGROUND:

Children with small or hypoplastic portal veins represent a challenge for liver transplantation. Graft loss of up to 70% has been reported in these patients in the past. A variety of techniques has been used in both cadaveric and living related transplants in an effort to overcome this problem. Variability arises as to whether to use a vascular graft and where on the portal system to attach the graft.

METHOD:

We present our usage of a simple and straightforward interposition iliac vein allograft fashioned in a manner to achieve large anastomotic cross-sectional area on the confluence of the superior mesenteric/splenic veins. The procedure also overcomes problems of graft vein/portal vein size mismatch in the cases where liver and vein grafts are procured from much larger donors.

RESULTS:

A total of 14 children presented with hypoplastic portal vein (diameter<5 mm), of a total of 30 consecutive patients requiring cadaveric liver transplants, and benefited from this technique. Median recipient age was 10.5 months. Revascularization times ranged from 22 to 43 min with a mean of 33 min. All patients are alive and well at a mean follow-up of 329 days (10 months). All liver grafts are well and functioning. No portal vein problem was detected.

CONCLUSION:

Results from this technique are clearly encouraging. Because portal vein hypoplasia is a common problem in pediatric transplant candidates, we believe this alternative technique is of interest and should be added to the transplant surgeon's armamentarium.

PMID:
11981415
[PubMed - indexed for MEDLINE]
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