Long-term follow-up of portal hypertension after liver transplantation in children.
We aimed to describe the long-term changes in the imaging and clinical features of PHALT in children. A retrospective review was undertaken of consecutive children undergoing their first liver transplant between 1993 and 2003. Details of clinical progress and ultrasound imaging were recorded at one-yr post-transplantation and at last follow-up. Data were extracted on 83 children (median age at transplant 1.7 yr, range one month to 17.5 yr, 44 girls) who underwent 89 transplants. Four of these children died at a mean 5.6 yr (range 3.8-6.9 yr) after transplantation. Of the survivors, follow-up at one yr (n = 83) and at last follow-up (n = 71, median 4.3 yr post-transplant) revealed imaging evidence of splenomegaly in 46% and 44%, ascites in 6% and 4%, and portal systemic collaterals in 12% and 14%, respectively. Gastrointestinal hemorrhage associated with portal hypertension had occurred in no children at one yr and in four (6%) at latest follow-up. Features of portal hypertension on ultrasound scan are common in children before liver transplantation. An important minority of children will suffer clinically significant complications of PHALT during long-term follow-up, caused by both vascular and parenchymal disease.
Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada. simon.ling@sickkids.ca
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SC
Ling
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Pfeiffer
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Y
Avitzur
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Fecteau
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Grant
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D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000503:physiopathology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies
D007166:Immunosuppressive Agents