Portal vein reconstruction in pediatric liver transplantation using end-to-side jump graft: A case report

Jaewon Lee; Nam-Joon Yi; Jae-Yoon Kim; Hyun Hwa Choi; Jiyoung Kim; Sola Lee; Su young Hong; Ung Sik Jin; Seong-Mi Yang; Jeong-Moo Lee; Suk Kyun Hong; YoungRok Choi; Kwang-Woong Lee; Kyung-Suk Suh

doi:10.14701/ahbps.22-125

Ann Hepatobiliary Pancreat Surg

Published online April 17, 2023; https://doi.org/10.14701/ahbps.22-125

Jaewon Lee¹, Nam-Joon Yi¹, Jae-Yoon Kim¹, Hyun Hwa Choi¹, Jiyoung Kim¹, Sola Lee¹, Su young Hong¹, Ung Sik Jin², Seong-Mi Yang³, Jeong-Moo Lee¹, Suk Kyun Hong¹, YoungRok Choi¹, Kwang-Woong Lee¹, Kyung-Suk Suh¹

¹Department of Surgery, Seoul National University College of Medicine, Seoul, Korea,
²Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea,
³Department of Anesthesiology and Pain Medicine, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea

Correspondence to: Nam-Joon Yi, MD, PhD
Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: +82-2-2072-2318, Fax: +82-2-766-3975, E-mail: gsleenj@snu.ac.kr
ORCID: https://orcid.org/0000-0002-5467-425X

Received December 2, 2022; Revised January 25, 2023; Accepted February 14, 2023.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.; Keywords : Liver transplantation; Interposition graft; Surgical complication; Hypoplasia; Stenosis