There were no grants or financial support, and there are no conflicts of interest. This study was approved by institutional review committee of Asan Medical Center.
Challenges and Controversies in Liver Transplantation
Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis
Article first published online: 26 MAR 2014
© 2014 American Association for the Study of Liver Diseases
Volume 20, Issue 5, pages 612–615, May 2014
How to Cite
Moon, D.-B., Lee, S.-G., Ahn, C.-S., Hwang, S., Kim, K.-H., Ha, T.-Y., Song, G.-W., Park, G.-C., Jung, D.-H., Namkoong, J.-M., Park, H.-W. and Park, Y.-H. (2014), Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis. Liver Transpl, 20: 612–615. doi: 10.1002/lt.23850
- Issue published online: 25 APR 2014
- Article first published online: 26 MAR 2014
- Accepted manuscript online: 7 FEB 2014 05:52AM EST
- Manuscript Accepted: 30 JAN 2014
- Manuscript Received: 10 NOV 2013
In total portosplenomesenteric thrombosis patients, cavoportal hemitransposition (CPHT) is indicated but rarely applicable for adult-to-adult (A-to-A) living donor liver transplantation (LDLT) because partial liver graft requires splanchno-portal inflow for liver graft regeneration. If intra- & peri-pancreatic collaterals draining into pericholedochal varix were present, pericholedochal varix may provide splanchnic blood flow to the transplanted liver and also relieve recipient's portal hypertension. To date, however, there is no successful report using pericholedochal varix in liver transplantation (LT). We successfully performed A-to-A LDLTs using pericholedochal varix for those 2 patients. The surgical strategies are followings: (a) dissection of hepatic hilum to isolate left hepatic artery using for arterial reconstruction of implanted right lobe graft, (b) en-mass clamping of the undissected remaining hilum if we can leave adequate length of stump from the clamping site, and then hilum is divided, (c) delay the donor hepatectomy until the feasibility of the recipient operation is confirmed. Portal flow was established between the sizable pericholedochal varix (caliber > 1cm) and graft portal vein, but the individually designed approaches were used for each patients. Currently, they have been enjoying normal life on posttransplant 92 and 44 months respectively. In conclusion, enlarged pericholedochal varix in patients with totally obliterated splanchnic veins might be an useful inflow to restore portal flow and secure good outcome in A-to-A LDLT. Liver Transpl 20:612–615, 2014. © 2014 AASLD.