1
|
Sierre S, Lambert G. Portal Venous Disease. Tech Vasc Interv Radiol 2024; 27:100959. [PMID: 39168546 DOI: 10.1016/j.tvir.2024.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Portal interventions in pediatric patients present unique difficulties when compared to adult procedures. In addition, children who need a portal intervention require a different workup and clinical management. Based on these elements, the clinical decisions for the study and treatment of these pathologies are different. This review is intended to present a summary of the interventional radiologist's role in treating pediatric portal venous diseases. Focus is placed on the technical elements, patient management and procedural indications while discussing different interventions involving the portal vein, providing some recommendations supported by recent research and the authors' experience.
Collapse
Affiliation(s)
- Sergio Sierre
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Buenos Aires, Argentina.
| | - Gonzalo Lambert
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Buenos Aires, Argentina
| |
Collapse
|
2
|
Goss MB, Leung DHB, Pouch SM, Munoz FM, Moulton EA, Lambing TMM, Koohmaraie S, Moreno NF, O'Mahony CA, Goss JA, Galván NTN. A new chapter in an evolving pandemic: Successful pediatric liver transplantation with SARS-CoV-2+ donors. Pediatr Transplant 2022; 26:e14407. [PMID: 36195971 PMCID: PMC9874761 DOI: 10.1111/petr.14407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Amid a viral pandemic with poorly understood transmissibility and pathogenicity in the pediatric patient, we report the first pediatric liver transplants utilizing allografts from SARS-CoV-2+ donors. METHODS We describe the outcomes of two pediatric liver transplant recipients who received organs from SARS-CoV-2 nucleic acid test-positive (NAT+) donors. Data were obtained through the respective electronic medical record system and UNet DonorNet platform. RESULTS The first donor was a 3-year-old boy succumbing to head trauma. One of four nasopharyngeal (NP) swabs and 1 of 3 bronchoalveolar lavage (BAL) NAT tests demonstrated SARS-CoV-2 infection before organ procurement. The second donor was a 16-month-old boy with cardiopulmonary arrest of unknown etiology. Three NAT tests (2 NP swab/1 BAL) prior to procurement failed to detect SARS-CoV-2. The diagnosis was made when the medical examiner repeated 2 NP swab NATs and an archive plasma NAT, all positive for SARS-CoV-2. Both 2-year-old recipients continue to do well 8 months post-transplant, with excellent graft function and no evidence of SARS-CoV-2 transmission. CONCLUSIONS This is the first report to describe successful pediatric liver transplantation from SARS-CoV-2+ donors. These data reinforce the adult transplant experience and support the judicious use of SARS-CoV-2+ donors for liver transplantation in children. With SARS-CoV-2 becoming endemic, the concern for donor-derived viral transmission must now be weighed against the realized benefit of life-saving transplantation in the pediatric population as we continue to work toward donor pool maximization.
Collapse
Affiliation(s)
| | - Daniel Hao Bin Leung
- Hepatology, and Nutrition Section, Department of Pediatrics, GastroenterologyBaylor College of MedicineHoustonTexasUSA
| | | | - Flor M. Munoz
- Division of Infectious Diseases, Department of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Elizabeth Andrea Moulton
- Division of Infectious Diseases, Department of PediatricsBaylor College of MedicineHoustonTexasUSA
| | | | - Sarah Koohmaraie
- Liver Transplantation ServiceTexas Children's HospitalHoustonTexasUSA
| | | | - Christine A. O'Mahony
- Division of Abdominal Transplantation, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - John A. Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Nhu Thao Nguyen Galván
- Division of Abdominal Transplantation, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTexasUSA
| |
Collapse
|
3
|
Moreno NF, Hernandez JA, Huang CS, Desai MS, Haug AB, Cleveland H, Upton A, Koohmaraie S, Goss MB, Leung DH, Banc-Husu AM, Justino H, Goss JA, Galvan NTN. Our evolution in the treatment of hepatic artery and portal vein thrombosis in pediatric liver transplantation: Success with catheter-directed therapies. Pediatr Transplant 2022; 26:e14306. [PMID: 35576052 DOI: 10.1111/petr.14306] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND In pediatric liver transplant recipients, hepatic artery thrombosis and portal vein thrombosis are major causes of acute graft failure and mortality within 30 days of transplantation. There is, however, a strong possibility of graft salvage if flow can be re-established to reduce ischemic injury. The current standard treatment is surgical revascularization, and if unsuccessful, retransplantation. Due to our success in treating these complications with catheter-directed therapies, we sought to summarize and publish the outcomes of all patients who experienced hepatic artery thrombosis or portal vein thrombosis within 30 days of liver transplantation. METHODS We conducted a retrospective cohort analysis of 27 pediatric liver transplant recipients who experienced hepatic artery thrombosis (n = 13), portal vein thrombosis (n = 9), or both (n = 5) between September 2012 and March 2021. We collected and tabulated data on the patients and therapies performed to treat them, including success rates, primary and secondary patency, and clinical outcomes. RESULTS Among these patients, 6 were managed with anticoagulation and relisting for transplant and 21 had a primary revascularization attempt. Surgical recanalization was attempted in 7 patients of which 3 had successful recanalization (43%) and catheter-directed recanalization was attempted in 14 patients with 100% success in re-establishing blood flow to the graft. Additionally, patency was increased, and mortality was decreased in patients treated with catheter-directed recanalization compared to surgical revascularization or anticoagulation alone. CONCLUSION This data illustrates the need to further investigate catheter-directed thrombolysis as a potential first-line treatment for postoperative HAT and PVT in pediatric liver transplant recipients.
Collapse
Affiliation(s)
- Nicolas F Moreno
- University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - Chun-Sing Huang
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Moreshwar S Desai
- Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Allison B Haug
- North Texas Area Community Health Center, Fort Worth, Texas, USA
| | - Heather Cleveland
- Department of Radiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ashley Upton
- Texas Children's Hospital, Department of Pediatric Radiology, Houston, Texas, USA
| | - Sarah Koohmaraie
- Texas Children's Hospital, Liver Transplantation Service, Houston, Texas, USA
| | - Matthew B Goss
- University of Texas McGovern Medical School, Houston, Texas, USA
| | - Daniel H Leung
- Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Anna M Banc-Husu
- Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Henri Justino
- Pediatric Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Nhu Thao N Galvan
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|