Portal vein thrombosis in biliary atresia patients after living donor liver transplantation.
BACKGROUND
Vascular complications are major complications after living donor liver transplantation (LDLT), especially in biliary atresia (BA). Early diagnosis and treatment of portal vein thrombosis (PVT) may ensure optimal graft function and good recipient survival. Our aim was to find any association between pre- and post-transplant anatomic characteristics and hemodynamics, and the occurrence of post-transplant PVT in BA patients undergoing LDLT.


METHODS
We evaluated the pre- and post-transplant findings in ultrasonography in 105 BA recipients who underwent primary LDLT to determine the possible associated factor(s) and ultrasonographic warning sign(s) that may cause PVT development after LDLT.


RESULTS
There were 53 male and 52 female recipients. The mean age, height, and weight were 2.8 years, 83.6 cm, and 12.5 kg, respectively. Occlusion of the portal vein (PV) developed in 8 patients. On multivariate analysis, the only independent, pretransplant risk factor predisposing to PV occlusion post-transplant was small main PV size (P = .008). Post-transplant ultrasonographic warning signs included PV flow <10 cm/sec (P = .003), high hepatic artery flow >70 cm/sec (P = .027), and lesser hepatic artery resistance index <0.65 (P = .013). Both slow PV flow <10 cm/sec and lesser hepatic artery resistance index have high sensitivity and specificity in predicting post-LDLT PVT.


CONCLUSIONS
Small PV size (<4 mm) and slow portal flow <10 cm/sec combined with lesser hepatic artery resistance index (<0.65) are strong warning signs that may predict the development of post-LDLT PVT in BA patients that require close monitoring.
Ou
Hsin-You
HY
Liver Transplant Program and Department of Diagnostic Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Concejero
Allan M
AM
Huang
Tung-Liang
TL
Chen
Tai-Yi
TY
Tsang
Leo Leung-Chit
LL
Chen
Chao-Long
CL
Yu
Pao-Chu
PC
Yu
Chun-Yen
CY
Cheng
Yu-Fan
YF
D000293:Adolescent; D000704:Analysis of Variance; D001656:Biliary Atresia / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D011169:Portal Vein; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D055815:Young Adult