title: Management of late-onset portal vein complications in pediatric living-donor liver transplantation.
abstract: The purpose of this study was to evaluate retrospectively the results of PTA for late-onset PV complications after pediatric LDLT and to assess whether a meso-Rex shunt is a viable option for treating restenosis of the PV after PTA in selected cases. Seventy-five children who underwent adult-to-child LDLT were included in this study, and there were six late-onset PV complications (8.0%). The initial therapeutic approach was PTA, with or without stent: PTA with balloon dilation for three children, PTA with stent placement for one child, and failure to cannulate the occluded PV for two children. A meso-Rex shunt was performed in the two children after failed PTA: One suffered complete obstruction of the main PV, and the other, restenosis with total thrombosis after PTA with stent. The PTA was a technical and clinical success in four with PV stenosis of the six patients (66.7%), and successful application of a meso-Rex shunt in the other two children resulted in restoration of PV flow. In conclusion, PTA is a safe and effective procedure for treating late-onset PV stenosis after pediatric LDLT. However, in growing pediatric recipients with restenosis of the PV after PTA or chronic PV thrombosis, a meso-Rex shunt may be a better choice for late-onset PV complications.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Yong-Pil
authors.initials: YP
authors.lastname: Cho
authors.forename: Kyung-Mo
authors.initials: KM
authors.lastname: Kim
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Jae-Yeon
authors.initials: JY
authors.lastname: Hwang
authors.forename: Hojong
authors.initials: H
authors.lastname: Park
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Chung
authors.forename: Taein
authors.initials: T
authors.lastname: Yoon
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Heungman
authors.initials: H
authors.lastname: Jun
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kwon
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000792:Angiography; D002648:Child; D002675:Child, Preschool; D004548:Elasticity; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology*; D007223:Infant; D017093:Liver Failure / Q000150:complications / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical; D012189:Retrospective Studies; D015607:Stents; D013927:Thrombosis / Q000473:pathology; D016896:Treatment Outcome
keywords: children; complications of liver transplantation; living donor liver transplantation; pediatric liver transplantation; portal hypertension