Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, Postal code: 35516, Egypt.
Liver Transplantation Unit, Gastrointestinal Surgery Center, Department of Anesthesia, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Langenbecks Arch Surg. 2023 Oct 4;408(1):387. doi: 10.1007/s00423-023-03115-9.
Portal vein (PV) reconstruction is a key factor for successful living-donor liver transplantation (LDLT). Anatomical variations of right PV (RPV) are encountered among potential donors.
To evaluate a single center experience of reconstruction techniques for the right hemi-liver grafts with PV variations during the period between May 2004 and 2022.
A total of 915 recipients underwent LDLT, among them 52 (5.8%) had RPV anatomical variations. Type II PV was found in 7 cases (13.5%), which were reconstructed by direct venoplasty. Type III PV was found in 27 cases (51.9%). They were reconstructed by direct venoplasty in 2 cases (3.8%), Y graft interposition in 2 cases (3.8%), and in situ double PV anastomoses in 23 cases (44.2%). Type IV PV was found in 18 cases (34.6%) and was reconstructed by Y graft interposition in 9 cases (17.3%), and in situ double PV anastomoses in 9 cases (17.3%). Early right posterior PV stenosis occurred in 2 recipients (3.8%). Early PV thrombosis occurred in 3 recipients (5.8%). The median follow-up duration was 54.5 months (4 - 185). The 1-, 3-, and 5-years survival rates were 91.9%, 86%, and 81.2%, respectively. Late PV stenosis occurred in 2 recipients (3.8%) and was managed conservatively.
Utilization of potential living donors with RPV anatomic variations may help to expand the donor pool. We found that direct venoplasty and in situ dual PV anastomoses techniques were safe, feasible, and associated with successful outcomes.
门静脉（PV）重建是活体肝移植（LDLT）成功的关键因素。在潜在供体中，右门静脉（RPV）存在解剖变异。
评估 2004 年 5 月至 2022 年期间，右半肝移植物存在 PV 变异时，重建技术的单中心经验。
915 名受者接受了 LDLT，其中 52 名（5.8%）存在 RPV 解剖变异。7 例（13.5%）存在 II 型 PV，采用直接静脉成形术重建。27 例（51.9%）存在 III 型 PV，其中 2 例（3.8%）采用 Y 型移植物间置术重建，23 例（44.2%）采用原位双 PV 吻合术重建。18 例（34.6%）存在 IV 型 PV，9 例（17.3%）采用 Y 型移植物间置术重建，9 例（17.3%）采用原位双 PV 吻合术重建。2 例（3.8%）受者出现早期右后支 PV 狭窄，3 例（5.8%）受者出现早期 PV 血栓形成。中位随访时间为 54.5 个月（4-185）。1、3、5 年生存率分别为 91.9%、86%和 81.2%。2 例（3.8%）受者出现晚期 PV 狭窄，行保守治疗。
利用 RPV 解剖变异的潜在活体供者可有助于扩大供者库。我们发现，直接静脉成形术和原位双 PV 吻合术是安全、可行的，且与良好的结果相关。
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