Section 8. Management of portal venous complications in pediatric living donor liver transplantation.
Portal vein (PV) complications after living donor liver transplant (LDLT) have been a major concern in pediatric liver transplantation. The incidence of PV complications is more in pediatric (0%-33%) than in adult recipients. Early diagnosis and treatment of PV complications may ensure optimal graft function and good recipient survival. Small preoperation PV size (<4 mm) and slow portal flow (<10 cm/s) combined with lower hepatic artery resistance index (<0.65) are strong warning signs that may predict the development of post LDLT PV complications. Portal vein angioplasty/stenting is conventionally performed through the percutaneous transhepatic approach; however, this can also be performed through transjugular, trans-splenic, and intraoperative approaches. Depending on the situation, using optimal method is the key point to minimize complication (5%) and gain high success rate (80%). PV occlusion of greater than 1 year with cavernous transformation seems to be a factor causing technical failure. Good patency rate (100%) with self-expandable metallic stents was noted in long-term follow-up. In conclusion, PV stent placement is an effective, long-term treatment modality to manage PV complications after pediatric LDLT. Early diagnosis and treatment are essential to maximize the use of stent placement and achieve good success rates.
1 Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 2 Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 3 Division of Hepatogastroenterology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 4 Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 5 Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Taiwan. 6 Address correspondence to: Chao-Long Chen, M.D., Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Tai-Pei Road, Niao-Sung, Kaohsiung 83305, Taiwan.
Yu-Fan
YF
Cheng
Hsin-You
HY
Ou
Chun-Yen
CY
Yu
Leo Leung-Chit
LL
Tsang
Tung-Liang
TL
Huang
Tai-Yi
TY
Chen
Allan
A
Concejero
Chih-Chi
CC
Wang
Shih-Ho
SH
Wang
Tsan-Shiun
TS
Lin
Yueh-Wei
YW
Liu
Chin-Hsiang
CH
Yang
Chee-Chien
CC
Yong
King-Wah
KW
Chiu
Bruno
B
Jawan
Hock-Liew
HL
Eng
Chao-Long
CL
Chen
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D007223:Infant; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency