title: Hepatic Histology and Morphometric Measurements in Idiopathic Extrahepatic Portal Vein Thrombosis in Children, Correlated to Clinical Outcome of Meso-Rex Bypass.
abstract: The aim of this study was to correlate clinical, histologic, and morphometric features of the liver in children with extrahepatic portal vein thrombosis (EHPVT), with surgical outcome after Meso-Rex bypass (MRB).
  
  
  
  Idiopathic EHPVT, a significant cause of portal hypertension, is surgically corrected by MRB. Correlation of histologic and morphometric features of the liver with outcome has not been reported in children.
  
  
  
  We retrospectively reviewed clinical and intraoperative data of 45 children with idiopathic EHPVT. Liver samples were obtained at the time of MRB. Morphometric measurements of portal tract structures were performed and correlated with surgical outcome. Median follow-up was 3.65 years after surgery (range 1.5 to 10 years).
  
  
  
  Thirty-seven (82.2%) children had successful MRB. There was no association between age, sex, and suture material with surgical outcome. Average patient age was higher in patients with postoperative complications (P = NS). Portal fibrosis, bridging, parenchymal nodules, portal inflammation, hepatocellular swelling, steatosis, dilatation of portal lymphatics, and periductal fibrosis did not show a significant difference between the 2 groups. Portal vein and bile duct area index were significantly smaller in the unsuccessful group (P = 0.004 and 0.003, respectively). A portal vein area index <0.08 had a lower chance of successful surgical outcome. Hepatic artery area index was not significantly different. Measured intraoperative portal blood inflow was the only significant clinical factor affecting surgical outcome (P = 0.0003).
  
  
  
  Low portal vein area index and intraoperative portal blood inflow may be negative prognostic factors for MRB outcome in children with idiopathic EHPVT. Average patient age was higher, although not statistically significant, in patients with postoperative complications.
authors.affiliation: Division of Pediatric Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Niramol
authors.initials: N
authors.lastname: Tantemsapya
authors.affiliation: Division of Transplant Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Superina
authors.affiliation: Biostatistics Research Core, Children's Memorial Research Center, Chicago, IL.
authors.forename: Deli
authors.initials: D
authors.lastname: Wang
authors.affiliation: Thomas Jefferson University Hospital, Department of Family Medicine, Jefferson Medical University, Philadelphia, PA.
authors.forename: Grace
authors.initials: G
authors.lastname: Kronauer
authors.affiliation: Division of Hepatology, Gastroenterology and Nutrition, Ann and Robert H. Lurie, Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Whitington
authors.affiliation: Department of Pathology, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Hector
authors.initials: H
authors.lastname: Melin-Aldana
mesh_terms: D000367:Age Factors; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008099:Liver / Q000473:pathology*; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications; D012039:Regional Blood Flow; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000150:complications / Q000473:pathology* / Q000601:surgery*