For a patient with portal vein thrombus, several reconstruction techniques have been reported up to date including thrombectomy, anastomosis with SMV or collateral veins using jumping graft. We retrospectively analyzed the anastomosis techniques of 65 LDLT cases which were performed at our facility from June 2000 to June 2012. Among them, 4 cases were classified into Yerdel Classification Grade 3 (6.2%) and 2 cases into Grade 4 (3.0%). Among Grade 3 cases, 2 cases were anastomosed with graft portal vein using external iliac vein graft through posterior surface of the pancreas, and two cased through anterior using the same vein as jumping graft. For Grade 4 cases, both cases were anastomosed with left gastric vein using the same vein graft. Of all the six cases, one recipient died from the recurrence of HCC, and the remaining five recipients are alive with patent portal vein and no complication. From our cases, it was proved that portal vein reconstruction for the recipients with portal vein thrombus could be performed using jumping graft or anastomosis with left gastric vein. However, as LDLT cases have limited vessel graft compared to DDLT, operative procedure should be planned after a substantial discussion including the supply of vessel graft.

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