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The impact of portal vein reconstruction on portal vein complications after pediatric living-donor liver transplantation with left lobe graft

  • Jiashu Ren
    Affiliations
    The First Central Clinical School, Tianjin Medical University, China
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  • Chong Dong
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Chao Sun
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Kai Wang
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Wei Zhang
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Weiping Zheng
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Hong Qin
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Chao Han
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Yang Yang
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Fubo Zhang
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Xinzhe Wei
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
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  • Wei Gao
    Correspondence
    Reprint requests: Wei Gao, MD, PhD, Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin 300192, China.
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, China

    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China
    Search for articles by this author
  • Hong Zheng
    Correspondence
    Reprint requests: Hong Zheng, MD, PhD, Organ Transplantation Center, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin 300192, China.
    Affiliations
    Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, China

    Organ Transplantation Center, Tianjin First Central Hospital, China

    Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, Tianjin First Central Hospital, China

    Research Institute of Transplant Medicine, Nankai University, China
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Published:November 21, 2022DOI:https://doi.org/10.1016/j.surg.2022.10.020

      Abstract

      Background

      This study aimed to determine whether the different methods of portal vein reconstruction have an impact on the occurrence of portal vein complications after pediatric living-donor liver transplantation with left lobe graft.

      Methods

      A total of 567 recipients were eligible for enrollment in this study and were divided into the following 2 groups according to the type of portal vein reconstruction: group 1 underwent anastomosis of the left and right bifurcations of the recipient portal vein to the donor portal vein (type 1), whereas group 2 underwent anastomosis of the bevel formed by the main trunk and right branch of the recipient portal vein to the donor portal vein (type 2). Postoperative portal vein complications and recipient and graft survival rates were compared between the 2 groups before and after propensity score matching.

      Results

      Portal vein complications occurred in 53 (9.3%) patients, including 46 recipients with portal vein stenosis and 7 with portal vein thrombosis. After propensity score matching, the incidence of portal vein stenosis in group 2 was lower than that in group 1 (P = .035). The first diagnosis time of portal vein stenosis in group 2 was later than that in group 1 (P = .033), and the incidence of early portal vein stenosis was lower than that in group 1 (P = .009). There were no statistically significant differences in the incidence of portal vein thrombosis and recipient and graft survival rates between the 2 groups.

      Conclusions

      Type 2 portal vein reconstruction appears to be a viable technique in pediatric living-donor liver transplantation with left lobe graft that can effectively reduce the incidence of portal vein stenosis.
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      References

        • Shehata M.R.
        • Yagi S.
        • Okamura Y.
        • et al.
        Pediatric liver transplantation using reduced and hyper-reduced left lateral segment grafts: a 10-year single-center experience.
        Am J Transplant. 2012; 12: 3406-3413
        • Rawal N.
        • Yazigi N.
        Pediatric liver transplantation.
        Pediatr Clin North Am. 2017; 64: 677-684
        • Gao W.
        • Song Z.
        • Ma N.
        • et al.
        Utility of neonatal donors in pediatric liver transplantation: a single-center experience.
        Pediatr Transplant. 2019; 23e13396
        • Raices M.
        • Czerwonko M.E.
        • Ardiles V.
        • et al.
        Short- and long-term outcomes after live-donor transplantation with hyper-reduced liver grafts in low-weight pediatric recipients.
        J Gastrointest Surg. 2019; 23: 2411-2420
        • Yamamoto H.
        • Khorsandi S.E.
        • Cortes-Cerisuelo M.
        • et al.
        Outcomes of liver transplantation in small infants.
        Liver Transpl. 2019; 25: 1561-1570
        • Jain A.K.
        • Anand R.
        • Lerret S.
        • et al.
        Outcomes following liver transplantation in young infants: data from the SPLIT registry.
        Am J Transplant. 2021; 21: 1113-1127
        • Venick R.S.
        • Farmer D.G.
        • McDiarmid S.V.
        • et al.
        Predictors of survival following liver transplantation in infants: a single-center analysis of more than 200 cases.
        Transplantation. 2010; 89: 600-605
        • Perito E.R.
        • Roll G.
        • Dodge J.L.
        • Rhee S.
        • Roberts J.P.
        Split liver transplantation and pediatric waitlist mortality in the United States: potential for improvement.
        Transplantation. 2019; 103: 552-557
        • Diamond I.R.
        • Fecteau A.
        • Millis J.M.
        • et al.
        Impact of graft type on outcome in pediatric liver transplantation: a report From Studies of Pediatric Liver Transplantation (SPLIT).
        Ann Surg. 2007; 246: 301-310
        • Kasahara M.
        • Umeshita K.
        • Sakamoto S.
        • et al.
        Living donor liver transplantation for biliary atresia: an analysis of 2085 cases in the registry of the Japanese Liver Transplantation Society.
        Am J Transplant. 2018; 18: 659-668
        • Gao W.
        • Song Z.
        • Ma N.
        • et al.
        Application of pediatric donors in split liver transplantation: is there an age limit.
        Am J Transplant. 2020; 20: 817-824
        • Cuenca A.G.
        • Kim H.B.
        • Vakili K.
        Pediatric liver transplantation.
        Semin Pediatr Surg. 2017; 26: 217-223
        • Kamran Hejazi Kenari S.
        • Mirzakhani H.
        • Eslami M.
        • Saidi R.F.
        Current state of the art in management of vascular complications after pediatric liver transplantation.
        Pediatr Transplant. 2015; 19: 18-26
        • Kanazawa H.
        • Sakamoto S.
        • Fukuda A.
        • et al.
        Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia.
        J Pediatr Surg. 2012; 47: 523-527
        • Sakamoto S.
        • Sasaki K.
        • Kitajima T.
        • et al.
        A novel technique for collateral interruption to maximize portal venous flow in pediatric liver transplantation.
        Liver Transpl. 2018; 24: 969-973
        • Yabuta M.
        • Shibata T.
        • Shibata T.
        • et al.
        Long-term outcome of percutaneous transhepatic balloon angioplasty for portal vein stenosis after pediatric living donor liver transplantation: a single institute's experience.
        J Vasc Interv Radiol. 2014; 25: 1406-1412
        • Baheti A.D.
        • Sanyal R.
        • Heller M.T.
        • Bhargava P.
        Surgical techniques and imaging complications of liver transplant.
        Radiol Clin North Am. 2016; 54: 199-215
        • Craig E.V.
        • Heller M.T.
        Complications of liver transplant.
        Abdom Radiol (NY). 2021; 46: 43-67
        • Chawla Y.
        • Duseja A.
        • Dhiman R.K.
        Review article: the modern management of portal vein thrombosis.
        Aliment Pharmacol Ther. 2009; 30: 881-894
        • Austin P.C.
        Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.
        Pharm Stat. 2011; 10: 150-161
        • Austin P.C.
        Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.
        Stat Med. 2009; 28: 3083-3107
        • Buell J.F.
        • Funaki B.
        • Cronin D.C.
        • et al.
        Long-term venous complications after full-size and segmental pediatric liver transplantation.
        Ann Surg. 2002; 236: 658-666
        • Ueda M.
        • Oike F.
        • Kasahara M.
        • et al.
        Portal vein complications in pediatric living donor liver transplantation using left-side grafts.
        Am J Transplant. 2008; 8: 2097-2105
        • Stevens J.P.
        • Xiang Y.
        • Leong T.
        • Naik K.
        • Gupta N.A.
        Portal vein complications and outcomes following pediatric liver transplantation: data from the Society of Pediatric Liver Transplantation.
        Liver Transpl. 2022; 28: 1196-1206
        • de Magnée C.
        • Bourdeaux C.
        • De Dobbeleer F.
        • et al.
        Impact of pre-transplant liver hemodynamics and portal reconstruction techniques on post-transplant portal vein complications in pediatric liver transplantation: a retrospective analysis in 197 recipients.
        Ann Surg. 2011; 254: 55-61
        • Gurevich M.
        • Guy-Viterbo V.
        • Janssen M.
        • et al.
        Living donor liver transplantation in children: surgical and immunological results in 250 recipients at Université Catholique de Louvain.
        Ann Surg. 2015; 262: 1141-1149
        • Sabra T.A.
        • Okajima H.
        • Yoshizawa A.
        • et al.
        Portal vein reconstruction using vein grafts in pediatric living donor liver transplantation: current status.
        Pediatr Transplant. 2017; 21
        • Sakamoto S.
        • Uchida H.
        • Kitajima T.
        • et al.
        The outcomes of portal vein reconstruction with vein graft interposition in pediatric liver transplantation for small children with biliary atresia.
        Transplantation. 2020; 104: 90-96
        • Saglam K.
        • Sahin T.T.
        • Usta S.
        • et al.
        Portal vein reconstruction with cryopreserved vascular grafts: a two-edged sword.
        Pediatr Transplant. 2022; 26e14206
        • Jensen M.K.
        • Campbell K.M.
        • Alonso M.H.
        • Nathan J.D.
        • Ryckman F.C.
        • Tiao G.M.
        Management and long-term consequences of portal vein thrombosis after liver transplantation in children.
        Liver Transpl. 2013; 19: 315-321
        • Badawy A.
        • Brunner S.M.
        • Knoppke B.
        • et al.
        Predictors of portal vein complications after pediatric liver transplantation: a German center experience.
        Pediatr Transplant. 2022; e14298
        • Abdelaziz O.
        • Attia H.
        Doppler ultrasonography in living donor liver transplantation recipients: intra- and post-operative vascular complications.
        World J Gastroenterol. 2016; 22: 6145-6172