Dual right portal vein graft versus type-I portal vein graft transplant with interpretation according to portal vein type and reconstruction technique

Abdelrahman, Mostafa O.; Rayan, Mahmoud T.; Omar, Wael; Salah, Manar; Allam, Islam; Gouda, Mohammed H.

doi:10.4103/ejs.ejs_77_22

Dual right portal vein graft versus type-I portal vein graft transplant with interpretation according to portal vein type and reconstruction technique

Authors

Abstract

Introduction
Living-donor liver transplantation (LDLT) has been developed as an alternative procedure for adult and pediatric patients with end-stage liver diseases awaiting deceased-donor liver transplant. Although children and small-sized adults get benefit from left-sided grafts, larger size of right-liver graft makes it preferable in terms of LDLT. However, anatomic variations have higher incidence in right-lobe than left-sided grafts, this leads to surgical difficulties and complications. Anomalous portal vein branching (APVB) that results in dual portal vein (PV) openings is one of the common variations with a reported incidence of 6–22%. Several techniques were innovated to overcome this problem.
Aim
The aim was to compare the outcome of LDLT with right-lobe graft associated with APVB to the right-lobe LDLT with ordinary PV anatomy in both donors and recipients, and to compare between the outcome of different techniques of PV reconstruction in cases of APVB.
Patients and methods
In total, 168 grafts (group B) containing type-I PV were compared with 31 grafts (group A) with APVB as regards recipient outcome after transplantation, interpretation of outcome after each reconstruction technique, and according to PV type that was done.
Results
Portal vein thrombosis (PVT) was significantly higher in group A (9.6%) than group B (2.4%). Group A and group B had 90-day mortality rate as 13 and 11.3%, respectively, cumulative mortality in group A and group B was 22.5 and 18.5%, respectively.
Conclusion
Dual right PV grafts could be accepted with satisfactory results with technical advancement in comparison with our previous experience, PVT is the main cause for mortality in APVB group. Our survival rates are accepted in comparison with international rates. All techniques for reconstruction could be tailored as case by case, all techniques could bring good outcome in suitable patients by trained hands.

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