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Original Article

Korean J Transplant 2019; 33(4): 106-111

Published online December 31, 2019

https://doi.org/10.4285/jkstn.2019.33.4.106

© The Korean Society for Transplantation

Long-term results of conjoined unification venoplasty for multiple portal vein branches of the right liver graft in living donor liver transplantations

Sung Yeon Yoo1, Shin Hwang1, Tae-Yong Ha1, Gi-Won Song1, Dong-Hwan Jung1, Gil-Chun Park1, Chul-Soo Ahn1, Deok-Bog Moon1, Ki-Hun Kim1, Young-In Yoon1, Yo-Han Park2, Hui-Dong Cho1, Yong-Kyu Chung1, Sang-Hyun Kang1, Jin-Uk Choi1, Sung-Gyu Lee1

1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;
2Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Correspondence to: Shin Hwang
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-3930, Fax: +82-2-3010-6701 E-mail: shwang@amc.seoul.kr

Received: July 28, 2019; Revised: September 30, 2019; Accepted: October 1, 2019

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

Background: Autologous portal vein Y-graft (PYG) interposition has been the standard procedure for reconstruction of double portal vein (PV) orifices of right liver grafts during living donor liver transplantations. However, it has the disadvantage of being vulnerable to anastomotic stenosis. A refined technique of conjoined unification venoplasty (CUV) was developed to secure PV reconstruction.
Methods: We reviewed the surgical outcomes in PV reconstructions using CUVs in 21 cases which were followed up for >3 years.
Results: The mean age of recipients was 51.7±4.9 years. The model for end-stage liver disease score was 15.3±6.4. The graft-recipient weight ratio was 1.12±0.21. Recipient PYGs were harvested in all cases. All living donors were blood relatives or relatives through marriage with type III PV anomalies. The number of right liver graft PV orifices was two in 19 cases and three in two cases. For the central intervening vein patch, a PV segment was used in six cases, and an autologous greater saphenous vein patch was used in the remaining 15 cases. The 21 patient cohort displayed a 100% 4-year patient survival rate. None of them underwent any PV interventions including interventional stenting. Serial follow-up computed tomography scans revealed that the reconstructed PV showed early reshaping with a stable streamlined configuration for over 3 years.
Conclusions: PV reconstruction using the CUV technique appears to be significantly more effective in preventing PV complications. We believe that CUV is a useful technique to reconstruct right liver grafts with multiple PV orifices.

Keywords: Living donor liver transplantation, Y-graft, Portal vein anomaly, Anastomotic stenosis