Long-term results of portal vein reconstruction with venous homograft interposition in paediatric split liver transplantation for biliary atresia

Background Patients with biliary atresia (BA) undergoing liver transplantation (LT) often have complex portal vein (PV) reconstructions due to PV hypoplasia. The use of venous homograft (VH) interposition is a surgical option in demanding PV reconstruction to guarantee optimal venous inflow. The long-term outcomes of this procedure are still unclear. Methods We selected patients under 3 years of age affected by BA who underwent split liver transplantation (SLT) between 2006 and 2010 at our centre. We compared the outcomes of patients who underwent PV reconstruction with or without VH interposition (VH group vs non-VH group). The primary endpoint was the occurrence of PV complications (PVCs) or the need for retransplantation (Re-Tx) within 6 months. Secondary endpoints included posttransplant outcomes, graft survival and patient survival. Results A total of 52 patients was selected. The median age and weight were 0.88 years and 7.45 kg. A hypoplastic PV was intraoperatively described in 50.0% of patients. 7 patients (13.5%) experienced PV complications (PVCs) or re-transplantation (Re-Tx) within 6 months. VH interposition was not a significant risk factor (p = 0.9). The secondary endpoints were also not influenced by the VH interposition. The patient and graft survival rates at 10 years were respectively 85% and 80% in the VH group compared to 93% (p = 0.4) and 76% (p = 0.8) in the non-VH group. Conclusions VH interposition in SLT for BA is a feasible and effective option for PV reconstruction. This procedure does not impact on PVCs or Re-Tx in the first 6 months and results in excellent long-term patient and graft survival rates at 10-years.