Risk factors for portal vein complications after pediatric living donor liver transplantation with left-sided grafts.
OBJECTIVE
Portal vein complications (PVC) after pediatric living donor liver transplantation (LDLT) have rarely been reported. We evaluated the long-term incidence and of the risk factors for PVC after pediatric LDLT.


METHODS
From April 1997 to November 2008, 96 pediatric patients underwent LDLT using left lateral segments or left lobes. We investigated recipient factors, donor factors, and operative factors through medical records. The portal vein sizes in 96 recipients ranged from 2.7 mm to 13.0 mm (median=5.0 mm). Portal vein reconstruction was usually performed with the graft portal vein anastomosed to the bifurcation of the recipient right and left portal veins, the so-called "branch patch".


RESULTS
PVC occurred in 11 patients (11.5%) including early PVC (n=3), late PVC (n=8). The disease-free survivals at 1, 5, and 10 years after LDLT were 94.7%, 88.7%, and 86.0%. Upon univariate analysis, a portal vein size<5 mm graft-to-recipient weight ratio (GRWR)>or=4%, transfusion volume>or=270 mL were significant risk factors for PVC. Body weight<8 kg and previous operative history tendes to be adverse for PVC. Upon multivariate analysis by Cox regression, portal vein size<5 mm was a highly significant factor for PVC after pediatric LDLT (hazard ratio=5.627, P=.027).


CONCLUSIONS
The disease-free survival at 10 years after LDLT was 86.0%. If the recipient's portal vein size<5 mm received a large-for-size graft (GRWR>or=4%), it is important to observe by regular Doppler ultrasonography follow-up to detect PVC.
Moon
J I
JI
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jung
G O
GO
Choi
G-S
GS
Kim
J M
JM
Shin
M
M
Kim
E Y
EY
Kwon
C H D
CH
Kim
S-J
SJ
Joh
J-W
JW
Lee
S-K
SK
D000293:Adolescent; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D015994:Incidence; D007223:Infant; D008099:Liver / Q000033:anatomy & histology; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D011169:Portal Vein / Q000473:pathology*; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology