Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Portal vein reconstruction in pediatric liver transplantation using end-to-side jump graft: A case report

  • Jaewon Lee (Department of Surgery, Seoul National University College of Medicine) ;
  • Nam-Joon Yi (Department of Surgery, Seoul National University College of Medicine) ;
  • Jae-Yoon Kim (Department of Surgery, Seoul National University College of Medicine) ;
  • Hyun Hwa Choi (Department of Surgery, Seoul National University College of Medicine) ;
  • Jiyoung Kim (Department of Surgery, Seoul National University College of Medicine) ;
  • Sola Lee (Department of Surgery, Seoul National University College of Medicine) ;
  • Su young Hong (Department of Surgery, Seoul National University College of Medicine) ;
  • Ung Sik Jin (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Seong-Mi Yang (Department of Anesthesiology and Pain Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Jeong-Moo Lee (Department of Surgery, Seoul National University College of Medicine) ;
  • Suk Kyun Hong (Department of Surgery, Seoul National University College of Medicine) ;
  • YoungRok Choi (Department of Surgery, Seoul National University College of Medicine) ;
  • Kwang-Woong Lee (Department of Surgery, Seoul National University College of Medicine) ;
  • Kyung-Suk Suh (Department of Surgery, Seoul National University College of Medicine)
  • Received : 2022.12.02
  • Accepted : 2023.02.14
  • Published : 2023.08.31
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Abstract

Attenuated portal vein (PV) flow is challenging in pediatric liver transplantation (LT) because it is unsuitable for classic end-to-end jump graft reconstruction from a small superior mesenteric vein (SMV). We thus introduce a novel technique of an end-to-side jump graft from SMV during pediatric LT using an adult partial liver graft. We successfully performed two cases of end-to-side retropancreatic jump graft using an iliac vein graft for PV reconstruction. One patient was a 2-year-old boy with hepatoblastoma and a Yerdel grade 3 PV thrombosis who underwent split LT. Another patient was an 8-month-old girl who had biliary atresia and PV hypoplasia with stenosis on the confluence level of the SMV; she underwent retransplantation because of graft failure related to PV thrombosis. After native PV was resected at the SMV confluence level, an end-to-side reconstruction was done from the proximal SMV to an interposition iliac vein. The interposition vein graft through posterior to the pancreas was obliquely anastomosed to the graft PV. There was no PV related complication during the follow-up period. Using a jump vascular graft in an end-to-side manner to connect the small native SMV and the large graft PV is a feasible treatment option in pediatric recipients with inadequate portal flow due to thrombosis or hypoplasia of the PV.

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References

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