Reconstruction of isolated caudate portal vein in left liver graft.

The addition of the caudate lobe to a left liver graft is known to increase graft volume by 9% and has been shown to be useful for overcoming borderline graft-recipient size mismatch in adult living donor liver transplantation. To assure full graft viability and regeneration, all of the feeding vessels for the caudate lobe should be preserved or reconstructed. However, more knowledge is needed about portal vein reconstruction for the caudate lobe. From January 1996 to August 2003, 238 living donor liver transplantations were performed at our institution. Of these, 67 donors underwent left hepatectomy with the caudate lobe and the middle hepatic vein. An isolated caudate portal vein originating from the left sidewall of the portal branches for the Spiegelian lobe (P1) was encountered in 9 donors (13.4%). The isolated P1 was reconstructed in 3 of the 9 cases using the pantaloon technique or interposition of an autovein graft. There were no complications related to P1 reconstruction and patency was confirmed by computerized tomography (CT) 1 month after transplantation. In the remaining 6 cases, the isolated P1 was very small (less than .5 mm) and did not require reconstruction. Isolated P1s are relatively rare, but when they are both present and large, it is advisable to undertake reconstruction that assures full graft function of the caudate lobe.