Umbilical Fissure Vein Anatomy and Its Importance in Monosegment 3 Graft Procurement for Liver Transplant: A Missed...

Liver transplant in infants weighing less than 6 kg presents substantial technical challenges, prompting various innovations to enhance outcomes. To mitigate the risk of "large-for-size syndrome," initial left lateral segment transplant techniques have evolved, including use of monosegment grafts procured along anatomical planes. Thorough understanding of segmental liver anatomy on radiological imaging is crucial for planning of monosegment grafts. Failure to identify anatomical variations preoperatively can lead to unexpected surgical findings and potentially affect outcomes. Here, we report a living donor liver transplant in which a segment 3 graft was used in a 5.5-kg infant with biliary atresia. We highlight 2 novel surgical issues encountered: (1) an unusual drainage pattern of the umbilical fissure vein in the donor and (2) the innovative application of a Contegra bovine jugular vein graft to reconstruct the atretic portal vein in the recipient. With adequate awareness and meticulous planning, successful outcomes can be achieved in most instances. Furthermore, the use of bovine jugular vein conduits represents an innovative approach in liver transplant. In situations where deceased donor grafts are not available, this option could potentially offer advantages over synthetic expanded polytetrafluoroethylene grafts. Our patient was discharged on postoperative day 16 with normal liver function tests and continues to have normal liver Doppler and function test results at 3 years after liver transplant.