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Saglam K, Sahin TT, Usta S, Koc C, Otan E, Kayaalp C, Aydin C, Yilmaz S. Portal vein reconstruction with cryopreserved vascular grafts: A two-edged sword. Pediatr Transplant 2022; 26:e14206. [PMID: 34889009 DOI: 10.1111/petr.14206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Portal vein anastomotic complications related to size discrepancy are important causes of morbidity and mortality in pediatric liver transplantation. Interposed vascular grafts in portal vein anastomosis can solve this problem. The aim of this study is to evaluate the results of pediatric liver transplantations performed using cryopreserved interposed vascular grafts between graft portal vein and superior mesenteric vein (SMV)-splenic vein (SpV) confluence. METHODS Twenty-nine pediatric patients received liver transplantation using cryopreserved venous grafts in our Liver Transplant Institute between 2013 and 2020 were included in this study. Demographic, clinical, and operative characteristics and postoperative follow-up were analyzed. RESULTS Sixteen patients (55.2%) had portal hypoplasia and five patients (17.2%) had portal vein thrombosis. In total, six patients (20.6%) suffered portal vein thrombosis in the early postoperative period. Three patients (10.3%) experienced portal vein thrombosis in the late postoperative period. Late portal vein thrombosis rate was significantly higher in patients with early portal vein thrombosis (3/6 patients [50%] versus 0/23 patients [0%]; p = .034). Lack of portal flow was significantly higher in patients with both early (50% versus 0%; p = .002) and late portal vein thrombosis (66.7% versus 6.7%; p = .03). CONCLUSION Preoperative portal vein thrombosis and insufficient flow are important factors affecting success of liver transplant in children. The use of interposed vein grafts in problematic portal anastomoses can overcome portal flow problems.
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Affiliation(s)
- Kutay Saglam
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sertac Usta
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemalettin Koc
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Emrah Otan
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemalettin Aydin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Geha JA, Galvan NTN, Rana A, Geha JD, O'Mahony CA, Goss JA. Replacement of the portal vein during orthotopic liver transplantation in the patient with biliary atresia. Pediatr Transplant 2018; 22:e13280. [PMID: 30105818 DOI: 10.1111/petr.13280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/18/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Affiliation(s)
- John A Geha
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - N Thao N Galvan
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Abbas Rana
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joseph D Geha
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Christine A O'Mahony
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - John A Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Rubio JS, Rumbo C, Farinelli PA, Aguirre N, Ramisch DA, Paladini H, D Angelo P, Barros Schelotto P, Gondolesi GE. Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living-related liver transplantation. Case report. Pediatr Transplant 2018; 22. [PMID: 29453782 DOI: 10.1111/petr.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 11/26/2022]
Abstract
Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of "steal flow syndrome" cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation.
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Affiliation(s)
- Juan S Rubio
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Carolina Rumbo
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina.,Pediatric Hepatology and Pediatric Liver Transplant Unit, Fundación Favaloro, Buenos Aires, Argentina
| | - Pablo A Farinelli
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Nicolás Aguirre
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Diego A Ramisch
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Hugo Paladini
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina.,Radiology Department, Fundación Favaloro, Buenos Aires, Argentina
| | - Pablo D Angelo
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina.,Radiology Department, Fundación Favaloro, Buenos Aires, Argentina
| | - Pablo Barros Schelotto
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Gabriel E Gondolesi
- Hepatology, HPB Surgery and Liver Transplant Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
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