Impact of New Portal Reconstruction Strategy on Portal Vein Growth and Outcomes in Living‐Donor Liver Transplantation for Small Children With Biliary Atresia

Background/Purpose We evaluated the outcomes of a new reconstruction method that we adopted in 2017 for small children with biliary atresia, involving aggressive resection of the sclerotic portal vein (PV), larger anastomotic orifice, and proactive vein graft interposition. Methods Data from 85 patients with biliary atresia (excluding one) aged < 3 years who underwent living‐donor liver transplantation from January 2011 to December 2022 were retrospectively reviewed. Patients were categorized into former (“before 2017”) and latter (“after 2017”) groups, comprising 47 and 38 patients, respectively, according to their surgery time. Results The percentage of trunk reconstruction cases decreased from 51% to 26%, whereas that of vein graft interposition cases increased from 38% to 68% ( p = 0.021). PV complication rates improved significantly from 19% to 3% ( p = 0.035). Over 6 months postoperatively, the PV diameter was < 6 mm in 44% of cases in the former group but improved to 0% in the latter group ( p < 0.01). Platelet counts at 1 year postoperatively were significantly higher in the latter group. Conclusions In living‐donor liver transplantation for small children with biliary atresia, aggressive resection of the sclerotic PV, large anastomotic orifice, and proactive vein graft interposition may reduce PV complications and provide appropriate portal dilation for body growth.