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Portal vein venoplasty safe, effective in pediatric liver transplantation

Portal vein venoplasty with autogenous patch was a simple and safe procedure that produced satisfactory outcomes in pediatric patients with poor portal vein characteristics who underwent living donor liver transplantation, according to a recently published study.

“Our novel [portal vein] venoplastic technique enlarges a hypoplastic portal vein through the insertion of an autogenous portal vein patch down to the site of normal size, which can be the confluence of the portal vein and the coronary vein,” Mingxuan Feng, MD, from the Shanghai Jiao Tong University, China, and colleagues wrote. “An autogenous patch is easily procured without additional injury and provides better histocompatibility, thus could be considered in all the venoplastic techniques using patch.”

The study comprised 16 children who required liver transplantation and received livers from living donors. The researchers designated the pediatric patients as high-risk cases based on intratransplantation observation of size less than 4.5 mm, sclerotic quality and reverse portal vein flow.

Median age of the 12 girls and four boys was 7 months (range, 6-16 months) and median weight was 6.8 kg (range, 5.1-9.7 kg). All but one of the patients had biliary atresia; the other patient had progressive familial intrahepatic cholestasis. Eight patients had reversed portal vein flow and three patients had fluctuant portal vein flow.

Feng and colleagues performed autogenous patch venoplastic portal vein reconstruction during transplantation, the aim of which was to enlarge the atretic portal vein without causing additional injury in normal tissues of either the donor liver or the pediatric patients. The researchers selected left lateral segments, two of which required size reduction, with a median graft-recipient weight ratio of 3.29% (range, 2.64%-5.77%).

Median portal vein diameter was 3.5 mm (range, 1.5-4.5 mm) and median coronary vein diameter was 3.7 mm (range, 1.1-5.1 mm). The researchers procured patches from the left branch in 14 cases and from the bifurcation of the portal vein in two cases. Median length of the patches was 37 mm (range, 31-42 mm) and median width was 7 mm (range, 5-9 mm).

Thirteen anastomoses were constructed on the confluence of the portal vein and the coronary vein. Portal veins were enlarged to a median diameter of 5.15 mm (range, 3.7-6.2 mm) following venoplasty.

All the pediatric patients obtained satisfactory portal flow after transplantation. No portal vein-related complications occurred during the median follow-up of 11 months (range, 1-18 months) and graft function recovered within 2 weeks. During follow-up, one child died of severe pulmonary infection.

“During the maximal follow-up period of 18 months, no [portal vein] complications occurred in this venoplasty series, and all the children are in good health, except for one child died from lung infection,” the researchers concluded. “Although longer follow up is still required, these encouraging results confirm the efficacy and safety of this improved venoplasty technique and support its routine application in pediatric [living donor liver transplantation].”

Disclosure: The authors report no relevant financial disclosures.