Anetrior sector outflow reconstruction is followed by most centers performing right lobe liver transplantation. Recanalised umbilical vein, cryopreserved cadaveric veins/ arteries, PTFE and Recipient's portal vein can be used. Cryopreserved veins & PTFE maintain patency for 1st few weeks and have been associated with infections, graft /GI fistula and pseudoaneurysms;autologous portal vein has demonstrated long term patency without other risks. For reconstructing both segment 5 and 8 veins 2 conduits are routinely used.We preserve Middle hepatic vein with the graft and segment 4 drainage in the donor. The anterior sector outflow is reconstructed as a single extension of the MHV. Y graft of portal confluence is used for separate segment 8 vein and MHV or separate segment 5 and 8 veins. Aims: Evaluate patency of Autologoous portal bifurcation utilized as a Y graft. Methods: Between April 2013 and July 2016, 101 right lobe LDLTs were performed. MHV extension was utilized in 89 recipients and Y graft anterior sector reconstruction in 14 recipients. Their follow up Doppler and /or CT scans were reviewed. Technique: During recipient hepatectomy we preserve the portal bifurcation with the explant and right and left portal veins along with bifurcation is obtained on the back table. Graft flushing and Y graft retrieval are done simultaneous with no prolongation of anhepatic phase or Cold ischemia. The anterior sector outflow is reconstructed as 2 limbs of Y; the vertical limb is anastomosed to IVC after RHV Anastomosis. Results: All 14 patients were male with a mean age of 46 years (alcoholic cirrhosis 5, NASH 4, AIH 2, Others 3). None of the Y grafts require adjunct hemostatic measures. 2 Patients died beyond 30 days; I due to IC bleed, other sepsis. Both had patent Y Graft at 1 mth. All Y grafts were patent at follow up (1 month to 28 mth, median 11 months). Conclusion: Autologous Portal vein bifurcation derived from explant liver provides excellent long term patency for anterior sector reconstruction when both segment 5 and 8 veins need to be drained. It has the advantage of avoiding any groin incision(saphenous graft), preventing immunological damage or cryopreservation induced damage when utilizing a non autologous / cryopreserved vessel and higher thrombosis rates reported with recanalised umbilical vein and PTFE grafts.

CITATION INFORMATION: Kapoor S, Nath B, Varma V, Sable S, Chauhan A, Kumaran V. Patency of Autologous Portal Vein “Y“ Graft in Anterior Sector Outflow Reconstruction in Adult Living Donor Right Lobe Grafts. Am J Transplant. 2017;17 (suppl 3).

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