Kilic M et al. (2008) A new surgical technique for hepatic vein reconstruction in pediatric live donor liver transplantation. Pediatr Transplant [doi:10.1111/j.1399-3046.2007.00877.x]

Hepatic venous outflow obstruction is a common complication of pediatric living donor liver transplantation (PLDLT). Turkish surgeons report a new technique for hepatic vein reconstruction in PLDLT recipients that reduces the incidence of hepatic vein stenosis and thrombosis.

Kilic et al. conducted a retrospective comparison of the outcomes for 61 consecutive children who underwent PLDLT with left lateral hepatic segments between 1999 and 2006. The first 32 children underwent direct anastomosis of the donor left hepatic vein to the common orifice of the recipient hepatic vein with continuous suturing of both the anterior and posterior walls. A change in technique was instituted for the second group of 29 children; continuous suturing was used for the posterior wall of the anastomosis, but interrupted suturing was used for the anterior wall.

The second group of patients was younger than the first (median age 40 months versus 12 months, and median weight 15 kg versus 8.1 kg, respectively). In the first group, there was one case of hepatic vein thrombosis and four of stenosis; there were no complications in the second group (P <0.05). All complications in the first group occurred within 6 months of surgery. Median follow-up was 52 months for the first group and 14 months for the second group.

The authors suggest that an interrupted anterior row of sutures allows for expansion of the anastomosis, which reduces problems associated with growth and rotation of the graft.