Conjoined Unification Venoplasty for Double Portal Vein Branches of Right Liver Graft: 1-Year Experience at a High-Volume Living Donor Liver Transplantation Center.

Autologous portal Y-graft (PYG) interposition has been regarded as the standard procedure for reconstruction of double portal vein (PV) orifices of right liver grafts during living donor liver transplantation, but it has the drawback of being vulnerable to functional PV stenosis. A refined technique of conjoined unification venoplasty (CUV) was developed to secure PV reconstruction. We reviewed the surgical experience on reconstruction of graft double PVs in 28 cases during a 1-year period of 2014. Computational simulation and modeling studies led us to develop CUV, which consists of placing a unification patch between two graft PV orifices and overlying the coverage with a crotch-opened autologous PYG, the shape of which provides a wide range of tolerance for alignment mismatching in PV anastomosis. During the 1-year study period, the numbers of patients using autologous PYG interposition, circumferential PV fencing with greater saphenous vein, homograft vein interposition, and CUV were 11, 3, 1, and 0, respectively, for 6 months before implementing CUV, and 5, 1, 1, and 6, respectively, for 6 months after implementing CUV. PV complications occurred in 2 of 16 patients with autologous PYG interposition, but no complications were observed in 12 patients operated on using other techniques including CUV. The drawback of conventional autologous PYG interposition can be overcome technically by CUV, which secures PV patency through hemodynamic-compliant offset of anatomical discrepancy and anastomotic alignment mismatching. We believe that CUV could be a useful and effective technical option for reconstruction of right liver grafts with two graft PVs.