Vascular complications after pediatric liver transplantation from the living donors.
Early arterial or portal vein thrombosis is a complications that can lead to graft loss and patient death or need of immediate retransplantation. The aim of the study was to assess the incidence, causes, treatment, and outcome of vascular thrombosis after living related donor liver transplantation (LRdLTx). Between 1999 and 2004 71 LRdLTx were performed in children aged from 6 months to 10 years. Vascular thrombosis was found in 12 recipients. Hepatic artery thrombosis (HAT) occurred in 4 (5.6%), portal vein thrombosis (PVT) in 8 (11.2%) cases. HAT occurred 5 to 8 days, PVT 1 to 22 days after LTx. Diagnosis of vascular thrombosis was confirmed by routine Doppler ultrasound examination. Thrombectomy was successful in one patient with HAT and in three patients with PVT. Venous conduit was performed in one patient with PVT after second thrombosis. Two children developed biliary strictures as a late complication of HAT and required additional surgical interventions. Two children with PVT developed portal hypertension with esophageal bleeding, which required surgical intervention; one another underwent endoscopic variceal ligation for grade III varices. Follow-up ranged from 7 to 60 months. One patient died as a result of HAT after retransplantation due to multiple intrahepatic abscesses 2 months after first transplant. Any risk factors of vascular thrombosis that can be controlled should be avoided after transplantation. Routine posttransplant Doppler examination should be performed at least twice a day within 7 to 14 posttransplant days. Immediate thrombectomy should be always carried out to avoid late complications and even mortality.
Broniszczak
D
D
Children's Memorial Health Institute, Department of Pediatric Surgery and Organ Transplantation, Warsaw, Poland.
Szymczak
M
M
Kamiński
A
A
Chyzyńska
A
A
Ismail
H
H
Drewniak
T
T
Nachulewicz
P
P
Markiewicz
M
M
Teisseyre
J
J
Dzik
E
E
Lembas
A
A
Kaliciński
P
P
D002648:Child; D002675:Child, Preschool; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D018608:Ultrasonography, Doppler; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*