title: Cavo-portal transposition in pediatric liver transplant recipients.
abstract: BACKGROUND
  Cavo-portal transposition (CPT) at liver transplantation (LTx) allows portal revascularization of the liver in recipients in whom portal system thrombosis does not allow performance of porto-portal anastomosis. The aim was to present the cases of 2 children who underwent LTx and CPT in our institution.
  
  
  METHODS
  1. A 10-year-old boy, after Kasai procedure and living donor LTx, was qualified for retransplantation 9 years after first LTx complicated with late portal vein thrombosis, portal hypertension, hypersplenism, and multiple GI bleeding episodes, after splenectomy and meso-caval shunt preventing GI bleeding. At retransplant surgery, CPT was done. Actual follow-up was 40 months. Doppler ultrasound and angio CT show normal flow within the graft's portal vein. Biochemical parameters were within normal range. There was no bleeding from the gastrointestinal tract. 2. A 14-month-old child after Kasai procedure was qualified for living donor liver transplantation. During surgery, thrombosis of the recipient portal system was found, which was not diagnosed before. The CPT was done. There were no complications during the postoperative course. The actual follow-up was 32 months, and the patient is doing well, with normal liver and renal function, without hypersplenism or ascites. There was no gastrointestinal bleeding. Doppler ultrasound showed normal intrahepatic portal and arterial flow in the transplanted liver.
  
  
  CONCLUSIONS
  Cavo-portal transposition is an important option in portal vein revascularization in liver transplant recipients without access to the portal system. Long-term observation of these 2 cases did not show any late problems (e.g., bleeding from the gastrointestinal tract, renal function, hyperammonemia, ascites) related to cavo-portal transposition.
authors.affiliation: Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Szymczak
authors.affiliation: Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Helath Institute, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kaliciński
authors.affiliation: Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Helath Institute, Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kwiatkowski
authors.affiliation: Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Helath Institute, Warsaw, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Broniszczak
authors.affiliation: Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Helath Institute, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Stefanowicz
mesh_terms: D002648:Child; D005260:Female; D006084:Graft Rejection / Q000601:surgery; D006499:Hepatic Artery / Q000601:surgery*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D007223:Infant; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011169:Portal Vein / Q000601:surgery*; D012086:Reoperation; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000601:surgery*