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- Title
Impact of prolonged clamping of the portal vein during liver transplantation in infants with biliary atresia: renewed interest in a long-standing issue.
- Authors
Uchida, Hajime; Sakamoto, Seisuke; Shimizu, Seiichi; Takeda, Masahiro; Yanagi, Yusuke; Fukuda, Akinari; Kasahara, Mureo
- Abstract
Purpose: Various approaches to portal vein (PV) reconstruction have been described; however, there is still scope to improve the safety and efficiency of how PV anastomosis is performed in infants. Methods: We analyzed, retrospectively, the predictive factors for PV reanastomosis during living donor liver transplantation (LDLT) in 117 infants (< 1 year old) with biliary atresia (BA). Results: Twenty-six infants required PV reanastomosis because of intraoperative PV thrombosis in 21 and insufficient PV flow in 5. Univariate analysis identified multiple previous laparotomies and a prolonged anhepatic phase (AHP) as significant risk factors for repeated PV anastomosis. The AHP cutoff value for identifying patients requiring PV reanastomosis was 134 min. Multivariate analysis revealed prolonged AHP > 134 min (odds ratio, 15.98; 95% confidence interval, 5.05–50.6; P < 0.001) as an independent risk factor for repeated PV anastomosis. The plasma D-dimer and fibrinogen degradation product concentration just after reperfusion were significantly higher in patients requiring PV reanastomosis (P < 0.001). Patients requiring reanastomosis of the PV had a higher incidence of PV complications after LDLT than those who did not need PV reanastomosis (P = 0.01). Conclusion: Attempting to minimize the AHP is indispensable for successful LDLT in infants with BA.
- Subjects
PORTAL vein; BILIARY atresia; LIVER transplantation; INFANTS; REFERENCE values
- Publication
Surgery Today, 2021, Vol 51, Issue 8, p1292
- ISSN
0941-1291
- Publication type
Article
- DOI
10.1007/s00595-020-02212-2