Long-term outcome of percutaneous transhepatic balloon angioplasty for portal vein stenosis after pediatric living donor liver transplantation: a single institute's experience.
OBJECTIVE
To evaluate retrospectively the long-term outcomes of percutaneous transhepatic balloon angioplasty performed for portal vein stenosis (PVS) after pediatric living donor liver transplantation (LDLT).


METHODS
Between October 1997 and December 2013, of 527 pediatric patients (age < 18 y) who underwent LDLT in a single institution, 43 patients (19 boys, 24 girls; mean age, 4.1 y ± 4.1) were confirmed to have PVS at direct portography with or without manometry and underwent percutaneous interventions, including balloon angioplasty with or without stent placement. Technical success, clinical success, laboratory findings, manometry findings, patency rates, and major complications were evaluated. Follow-up periods after initial balloon angioplasty ranged from 5-169 months (mean, 119 mo).


RESULTS
Technical success was achieved in 65 of 66 sessions (98.5%) and in 42 of 43 patients (97.7%), and clinical success was achieved in 37 of 43 patients (86.0%). Platelet counts improved significantly. Of 32 patients undergoing manometry, 19 showed significant improvement of pressure gradient across the stenosis after percutaneous transhepatic balloon angioplasty. At 1, 3, 5, and 10 years after balloon angioplasty, the rates of primary patency were 83%, 78%, 76%, and 70%, and the rates of primary-assisted patency were 100%, 100%, 100%, and 96%. Two major complications subsequent to balloon angioplasty were noted: severe asthma attack and portal vein thrombosis.


CONCLUSIONS
Percutaneous transhepatic balloon angioplasty is a safe and effective treatment with long-term patency for PVS after pediatric LDLT.
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Minoru
M
Yabuta
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. Electronic address: ksj@kuhp.kyoto-u.ac.jp.
Toshiya
T
Shibata
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Toyomichi
T
Shibata
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Ken
K
Shinozuka
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Hiroyoshi
H
Isoda
Department of Surgery, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Shinya
S
Okamoto
Department of Surgery, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Shinji
S
Uemoto
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Kaori
K
Togashi
D000293:Adolescent; D000367:Age Factors; D000800:Angioplasty, Balloon / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D019520:Living Donors; D008297:Male; D008365:Manometry; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D011172:Portography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency; D055815:Young Adult