Alternative strategy for handling portal vein tearing around chronic calcification in living donor liver transplantation

Portal vein preparation for inflow anastomosis is a critical step in liver transplantation.Although portal vein thrombosis is well documented and classified according to Yerdel grading, calcification or sclerosis of the portal vein is rarely reported.Segmental or diffuse calcification of portal vein compromises its structural integrity and may even result in flow obstruction, rendering it unsuitable for reconstruction and necessitating alternative inflow strategies.This case report describes a patient with portal vein tearing around chronic calcification who underwent successful living donor liver transplantation using a cryopreserved iliac vein graft anastomosed to gastric varices.