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. 2023 Apr 10;9(1):57.
doi: 10.1186/s40792-023-01641-8.

Thrombectomized autologous portal Y-graft inflow construction can be an option in living-donor liver transplantation: a case report

Munetoshi Akaoka  1 , Koichiro Haruki  2 , Kenei Furukawa  1 , Shinji Onda  1 , Shunta Ishizaki  1 , Masashi Tsunematsu  1 , Yoshihiro Shirai  1 , Norimitsu Okui  1 , Yoshiaki Tanji  1 , Toru Ikegami  1
Affiliations

Thrombectomized autologous portal Y-graft inflow construction can be an option in living-donor liver transplantation: a case report

Munetoshi Akaoka et al. Surg Case Rep. .

Abstract

Background: In living-donor liver transplantation (LDLT), portal Y-graft interposition using the recipient's portal vein (PV) bifurcation has been used for right lobe grafts with double PV orifices. We herein report the use of thrombectomized autologous portal Y-graft interposition for a recipient with preoperative portal vein thrombosis (PVT) in a right lobe LDLT with double PV orifices.

Case presentation: The recipient was a 54-year-old male with end-stage liver disease due to alcoholic liver cirrhosis. There was PV thrombus in the recipient's PV. The living liver donor was his 53-year-old spouse, and a right lobe graft was planned for the transplantation. Since the donor's liver had a type III PV anomaly, autologous portal Y-graft interposition after thrombectomy was planned for PV reconstruction in the LDLT. The portal Y-graft was resected from the recipient and a thrombus extending from the main PV to the right PV branch was removed on the back table. The portal Y-graft was anastomosed to the anterior and posterior portal branches of the right lobe graft. Followed by venous reconstruction, the Y-graft was anastomosed to the recipient's main PV. The operation time was 545 min and the intraoperative blood loss was 1355 ml. The recipient was discharged on postoperative day 13 without any complications. The recipient remains well with the patency of the portal Y-graft one year after the liver transplantation.

Conclusion: We herein report the successful use of autologous portal Y-graft interposition after thrombectomy on the back table for a recipient with PVT in a right lobe LDLT.

Keywords: Living-donor liver transplantation; Portal Y-graft interposition; Portal vein thrombosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative imaging of recipient and donor. A, B Contrast-enhanced computed tomography showed a partially thrombosed main portal vein in the recipient (arrowheads). C Three-dimensional computed tomography showed the recipient’s portal vein which had standard anatomy and was narrowed by portal vein thrombosis (circle). D Three-dimensional computed tomography showed separating right anterior and right posterior portal veins in the donor (circle)
Fig. 2
Fig. 2
Autologous portal Y-graft interposition after thrombectomy. A Portal venous thrombus extending from the main portal vein (PV) to the right PV branch of resected portal Y-graft was easily removed on the back table. B Portal Y-graft after removal of thrombosis. There was no damage to the inner surface of portal Y-graft. C The right and left limbs of the portal Y-graft were anastomosed to the anterior and posterior portal branches of the right liver graft on the back table. D The main PV of the Y-graft was anastomosed to the remnant main PV of the recipient
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