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

대한이식학회지 2019년 33권 4호 p.106 ~ 111
 ( Yoo Sung-Yeon ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

황신 ( Hwang Shin ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
하태용 ( Ha Tae-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
송기원 ( Song Gi-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
정동환 ( Jung Dong-Hwan ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
박길춘 ( Park Gil-Chun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
안철수 ( Ahn Chul-Soo ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
문덕복 ( Moon Deok-Bog ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김기헌 ( Kim Ki-Hun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
윤영인 ( Yoon Young-In ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
박요한 ( Park Yo-Han ) - Inje University College of Medicine Busan Paik Hospital Department of Surgery
 ( Cho Hui-Dong ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Chung Yong-Kyu ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
강상현 ( Kang Sang-Hyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
최진욱 ( Choi Jin-Uk ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
이승규 ( Lee Sung-Gyu ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

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.

키워드

Living donor liver transplantation; Y-graft; Portal vein anomaly; Anastomotic stenosis
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