Biliary reconstruction before clamp removal to avoid portal vein thrombosis in pediatric living‐donor liver transplantation using hyper‐reduced left lateral segment grafts: A novel technical strategy

LT has become the treatment of choice for children with end‐stage liver disease. The scarcity of donors and the considerable mortality on waiting lists have propelled the related living‐donor techniques, especially in small children. This population need smaller and good quality grafts and are usual...

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Bibliographic Details
Published in:Pediatric transplantation 2019-09, Vol.23 (6), p.e13516-n/a
Main Authors: Glinka, Juan, Santibañes, Martin, Biagiola, David, D´Agostino, Daniel, Ardiles, Victoria, Ciardullo, Miguel, Mattera, Juan, Pekolj, Juan, Santibañes, Eduardo
Format: Article
Language:English
Subjects:
Anastomosis
Bile
Bile ducts
biliary reconstruction
Children
Liver
Liver diseases
Liver transplantation
Liver transplants
living donor liver transplantation
Morbidity
Mortality
Occlusion
pediatric liver transplantation
Portal vein
Thrombosis
transplantation
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Summary:LT has become the treatment of choice for children with end‐stage liver disease. The scarcity of donors and the considerable mortality on waiting lists have propelled the related living‐donor techniques, especially in small children. This population need smaller and good quality grafts and are usually candidates to receive a LLS from a related donor. Many times this grafts are still large and do not fit in the receptor's abdomen, so a further hyper‐reduction may be required. Despite all advances in LT field, vascular complications still occur in a considerable proportion remaining as a significant cause of morbidity, graft loss, and mortality. Technical issues currently play an essential role in its genesis. The widely spread technique for biliary and vascular reconstruction in living donor LT (LDLT) nowadays implies removal of the portal vein (PV) clamp after the venous anastomosis, then the arterial reconstruction is done, followed by the biliary reconstruction. However, due to the posterior location of the LLS bile duct, for its reconstruction, a rotation of the liver is required risking a potential transient PV occlusion leading to thrombosis afterward. We describe a new technique that involves performing biliary reconstruction after the PV anastomosis and before removing the vascular clamp, thus allowing to freely rotate the liver with less risk of PV occlusion and thrombosis.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.13516