Introduction : Spontaneous diversion of portal flow through collateral vessels into the systemic circulation is frequently found in recipients with severe portal hypertension. These spontaneously induced main portal vein atrophic change and made flow into the collateral even after the implantation of the allograft. Such changes can make transplantation surgery difficult. We described several methods for overcoming this situation with appropriated surgical techniques.

Methods : We performed living donor liver transplantation using 3 different anastomotic technique in the patients who had atrophic changes in the portal vein.

Results : (1) Venoplasty for enlarging the diameter with own portal vein: we enlarged the diameter of the recipient portal vein using their own portal vein stump patch. (2) Conduit with cryopreserved vessels: we dissected around SMV-SV junction and made conduit using the cryopreserved vessels. (3) Left gastric varix to portal vein anastomosis: If the recipients had large gastric varix and the variceal wall was thick enough to the anastomosis, we used that varix to the anastomosis.

Conclusions : It is important to select optimal methods of portal vein anastomosis in the patients with atrophic change on portal vein. If these methods are used properly, these three different methods could be a good option for overcoming each situation.