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Marra P, Franchi-Abella S, Hernandez JA, Ronot M, Muglia R, D'Antiga L, Sironi S. Percutaneous recanalization of non-cirrhotic extrahepatic portal vein obstruction in children: technical considerations in a preliminary cohort. Eur Radiol 2024:10.1007/s00330-024-11040-8. [PMID: 39242398 DOI: 10.1007/s00330-024-11040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 07/29/2024] [Accepted: 08/07/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVES Portal hypertension resulting from non-cirrhotic extrahepatic portal vein obstruction (EHPVO) in children has been primarily managed with the Meso-Rex bypass, but only a few patients have a viable Rex recessus, required by surgery. This study reports a preliminary series of patients who underwent interventional radiology attempts at portal vein recanalization (PVR), with a focus on technical aspects and safety. METHODS A retrospective review of consecutive patients with severe portal hypertension due to non-cirrhotic EHPVO at a single institution from 2022, who underwent percutaneous attempts at PVR, was performed. Technical and clinical data including fluoroscopy time, radiation exposure, technical and clinical success, complications and follow-up were recorded. RESULTS Eleven patients (6 males and 5 females; median age 7 years, range 1-14) underwent 15 percutaneous transhepatic (n = 1), transplenic (n = 11), or simultaneous transhepatic/transplenic (n = 3) procedures. Rex recessus was patent in 4/11 (36%). Fluoroscopy resulted in a high median total dose area product (DAP) of 123 Gycm2 (range 17-788 Gycm2) per procedure. PVR was achieved in 5/11 patients (45%), 3/5 with obliterated Rex recessus. Two adverse events of grade 2 and grade 3 occurred without sequelae. After angioplasty, 4/5 patients required stenting to obtain sustained patency, as demonstrated by colour-Doppler ultrasound in all PVR after a median follow-up of 6 months (range 6-14). CONCLUSION Our preliminary experience suggests that 45% of children with non-cirrhotic EHPVO can restore portal flow even with obliterated Rex recessus. In non-cirrhotic EHPVO, PVR may be an option, if a Meso-Rex bypass is not feasible, although the radiation exposure deserves attention. CLINICAL RELEVANCE STATEMENT Innovative percutaneous procedures may have the potential to be an alternative option to the traditional surgical approach in the management of non-cirrhotic EHPVO and its complications in children not eligible for Meso-Rex bypass surgery. KEY POINTS Non-cirrhotic portal hypertension in children has been traditionally managed by surgery with Meso-Rex bypass creation. Percutaneous PVR may restore the patency of the native portal system even when the Rex recessus is obliterated and surgery has been excluded. Interventional radiological techniques may offer a minimally invasive solution in complex cases of EHPVO in children when Meso-Rex bypass is not feasible.
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Affiliation(s)
- Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, School of Medicine and Surgery, University of Milano Bicocca, Bergamo, Italy.
| | - Stephanie Franchi-Abella
- Department of Pediatric Radiology, DMU Smart Imaging, Bicêtre Hospital, AP-HP. Reference Centre for Vascular Diseases of the Liver, FSMR FILFOIE, ERN RARE LIVER, FHU Hépatinov, Le Kremlin-Bicêtre, France
- BIOMAPS UMR 9011 CNRS-INSERM-CEA, Paris-Saclay University, Paris, France
| | - José A Hernandez
- Department of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Maxime Ronot
- Service de Radiologie, Hôpital Beaujon APHP Nord, Clichy & Université Paris Cité, CRI, INSERM, Paris, France
| | - Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, School of Medicine and Surgery, University of Milano Bicocca, Bergamo, Italy
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, School of Medicine and Surgery, University of Milano Bicocca, Bergamo, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
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2
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Dong C, Song Z, Sun C, Wang K, Zhang W, Chen J, Zheng W, Yang Y, Wang Z, Han C, Jiao L, Zhang G, Xie E, Gao W, Shen Z. Basiliximab Induction and Postoperative Steroid-free Immunosuppression With Tacrolimus in Pediatric Liver Transplantation: A Randomized Clinical Trial. Transplantation 2024; 108:1769-1775. [PMID: 38419149 DOI: 10.1097/tp.0000000000004951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Optimizing the immunosuppressive regimen is essential to improve the long-term outcomes of pediatric liver transplant recipients. METHODS We conducted a prospective, randomized, open-label study to compare the safety and efficacy of 2 treatment approaches during pediatric liver transplantation: tacrolimus monotherapy following basiliximab induction (the study group) and a dual regimen of tacrolimus plus steroids (the control group). A total of 150 patients were enrolled, with 75 patients allocated to each group. RESULTS In both groups, recipients achieved graft and recipient overall survival rates exceeding 93%, with no statistically significant differences between them. However, the study group exhibited a significantly lower incidence of acute cellular rejection (ACR), delayed occurrence of ACR, and an improved ACR-free survival rate at 2 y compared with the control group. Notably, the study group also showed a significant reduction in the incidence of de novo donor-specific antibodies at 3-mo and 2-y posttransplant. Furthermore, 6 mo after the transplant, the study group demonstrated significant improvements in weight-for-age Z score and height-for-age Z score. No notable differences were observed in postoperative complications or the incidence of liver fibrosis between the 2 groups. CONCLUSIONS Basiliximab induction combine with tacrolimus (TAC) monotherapy is a safe and effective immunosuppressive regimen to reduce the episodes of ACR without influencing the development of liver fibrosis and graft and recipient survival rate after pediatric liver transplantation.
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Affiliation(s)
- Chong Dong
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhuolun Song
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chao Sun
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Kai Wang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Wei Zhang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Jing Chen
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Weiping Zheng
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Yang Yang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhen Wang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Chao Han
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Lijun Jiao
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Guofeng Zhang
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Enbo Xie
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Wei Gao
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Zhongyang Shen
- Department of Pediatric Transplantation, Tianjin First Central Hospital, Tianjin, China
- Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
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3
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Cavalcante ACBS, Carnevale FC, Zurstrassen CE, Pugliese RPS, Moreira AM, Assis AM, Matushita Junior JPK, Danesi VLB, Benavides MAR, Hirschfeld APM, Borges CBV, Miura IK, Porta G, Fonseca EA, ChapChap P, Neto JS. Recanalization of portal vein thrombosis after pediatric liver transplantation: Efficacy and safety of the transsplenic access. Pediatr Transplant 2024; 28:e14537. [PMID: 37550267 DOI: 10.1111/petr.14537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/09/2023] [Accepted: 04/13/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Endovascular management of portal vein thrombosis (PVT) is challenging. Transsplenic access (TSA) is growing as an access option to the portal system but with higher rates of bleeding complications. The aim of this article is to evaluate the efficacy and safety of transsplenic portal vein recanalization (PVR) using a metallic stent after pediatric liver transplantation. MATERIALS AND METHODS This is a retrospective review of 15 patients with chronic PVT who underwent PVR via TSA between February 2016 and December 2020. Two children who had undergone catheterization of a mesenteric vein tributary by minilaparotomy were excluded from the patency analysis but included in the splenic access analysis. The technical and clinical success of PVR and complications related to the procedure via TSA were evaluated. RESULTS Thirteen children with PVT were treated primarily using the TSA. The mean age was 4.1 years (range, 1.5-13.7 years), and the most common clinical presentation was hypersplenism (60%). Technically successful PVR was performed in 11/13 (84.6%) children, and clinical success was achieved in 9/11 (81.8%) children. No major complications were observed, and one child presented moderate pain in the TSA (from a total of 17 TSA). The median follow-up was 48.2 months. The median primary patency was 9.9 months. Primary patency in the first 4 years was 75%, and primary assisted patency was 100% in the follow-up period. CONCLUSIONS Transsplenic PVR is a safe and effective method for the treatment of PVT after pediatric liver transplantation.
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Affiliation(s)
| | | | | | - Renata Pereira Sustovich Pugliese
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | - Vera Lucia Baggio Danesi
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Marcel Albeiro Ruiz Benavides
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Adriana Porta M Hirschfeld
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Cristian B V Borges
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Irene Kazue Miura
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gilda Porta
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo Antunes Fonseca
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Paulo ChapChap
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
| | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
- Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, Brazil
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4
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de Assis A, de Carvalho Melo JA, Kawakami WY, Moreira AM, Carnevale FC, Massami H, Hirschfeld APM, Pugliese RPS, Foronda FK, Paulino RG, de Araújo AA, Fonseca EA, Seda Neto J. Life-threatening variceal bleeding after liver transplantation and extensive portal vein thrombosis: Desperate times call for desperate measures. Pediatr Transplant 2023; 27:e14555. [PMID: 37291909 DOI: 10.1111/petr.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The management of complex, intra- and extrahepatic portal vein thrombosis (PVT) after liver transplantation (LT) is challenging. Although most of the patients remain asymptomatic or oligosymptomatic in the chronic setting, some of them may develop severe portal hypertension and related complications, notably gastrointestinal (GI) bleeding. In the emergency scenario, clinical and endoscopic treatments as well as intensive support constitute the bases of conservative management, while more definitive treatment options such as surgical shunting and retransplantation are related to high morbidity rates. Transjugular intrahepatic portosystemic shunt (TIPS) was largely considered of limited role due to technical difficulties arising from extensive PVT. Recently, however, new minimally invasive image-guided techniques emerged, allowing portal vein recanalization and TIPS creation simultaneously (TIPS-PVR), even in complex PVT pretransplant patients. METHODS Herein, we describe a novel indication for TIPS-PVR in a post-LT adolescent presenting with life-threatening, refractory GI bleeding. RESULTS The patient presented with complete resolution of the hemorrhagic condition after the procedure, with no deterioration of hepatic function or hepatic encephalopathy. Follow-up Doppler ultrasound after TIPS-PVR showed normal hepatopetal venous flow within the stents, and no evidence of complications, including intraperitoneal or peri splenic bleeding. CONCLUSIONS This report describes the feasibility of TIPS-PVR in the post-LT scenario complicated by extensive PVT. In this case, a complete resolution of the life-threatening GI bleeding was achieved, with no major complications. Other patients with complex chronic PVT might benefit from the use of the described technique, but further studies are required to determine the correct timing and indications of the procedure, eventually before the occurrence of life-threatening complications.
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Affiliation(s)
| | | | | | | | | | - Hayashi Massami
- Pediatric Intensive Care Unit, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | | | | | | | | | | | | | - João Seda Neto
- Hepatology and Liver Transplantation, Hospital Sírio-Libanês, São Paulo, Brazil
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5
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Cohen O, Efros O, Riva N, Ageno W, Soffer S, Klang E, Barg AA, Kenet G, Levy-Mendelovich S. Anticoagulant treatment for pediatric splanchnic vein thrombosis: a systematic review and meta-analysis. J Thromb Haemost 2023; 21:2499-2508. [PMID: 37225019 DOI: 10.1016/j.jtha.2023.05.014] [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] [Received: 01/18/2023] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The clinical characteristics of splanchnic vein thrombosis (SVT) in pediatric patients and its optimal treatment strategies are unknown. OBJECTIVES This study aimed to assess the effectiveness and safety of anticoagulant therapy for pediatric SVT. METHODS MEDLINE and EMBASE databases were searched up to December 2021. We included observational and interventional studies that enrolled pediatric patients with SVT and reported anticoagulant treatment and outcomes, including rates of vessel recanalization, SVT extension, venous thromboembolism (VTE) recurrence, major bleeding, and mortality. Pooled proportions of vessel recanalization were calculated with their 95% CI. RESULTS A total of 506 pediatric patients (aged 0-18 years) across 17 observational studies were included. The majority of patients had portal vein thrombosis (n = 308, 60.8%) or Budd-Chiari syndrome (n = 175, 34.6%). Most events were triggered by transient provoking factors. Anticoagulation (heparins and vitamin K antagonists) was prescribed in 217 (42.9%) patients, and 148 (29.2%) patients underwent vascular interventions. The overall pooled proportions of vessel recanalization were 55.3% (95% CI, 34.1%-74.7%; I2 = 74.0%) among anticoagulated patients and 29.4% (95% CI, 2.6%-86.6%; I2 = 49.0%) among non-anticoagulated patients. SVT extension, major bleeding, VTE recurrence, and mortality rates were 8.9%, 3.8%, 3.5%, and 10.0%, respectively, in anticoagulated patients and 2.8%, 1.4%, 0%, and 50.3%, respectively, in non-anticoagulated patients. CONCLUSION In pediatric SVT, anticoagulation appears to be associated with moderate recanalization rates and a low risk of major bleeding. VTE recurrence is low and comparable to that reported in pediatric patients with other types of provoked VTE.
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Affiliation(s)
- Omri Cohen
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Orly Efros
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel; Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel; Sheba Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel
| | - Assaf A Barg
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kenet
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarina Levy-Mendelovich
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel.
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6
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Ghibes P, Grözinger G, Hartleif S, Sturm E, Hefferman GM, Nadalin S, Tsiflikas I, Schäfer JF, Artzner C. Balloon angioplasty versus stent placement for the treatment of portal vein stenosis in children: a single center experience. Pediatr Radiol 2023; 53:1885-1893. [PMID: 37147428 DOI: 10.1007/s00247-023-05674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous interventional treatment of portal vein stenosis in children. MATERIAL AND METHODS A retrospective analysis of all interventional treatments for portal vein stenosis in pediatric patients at a single institution from 2010 to 2021 was conducted. Platelet count, spleen size and portal vein flow velocity were assessed during the follow-up period. Primary and primary assisted patency time were determined. RESULTS A total of ten children (median age 28.5 months, interquartile range (IQR): 2.75-52.5 months) with portal vein stenosis after Mesorex-Shunt (n = 4), liver transplantation (n = 3) and other etiologies (n = 3) underwent 15 interventional procedures. There were five reinterventions and one discontinued intervention. The technical success rate was 93.3% (14/15) and clinical success of treated patients was 100% (14/14). Median follow-up was 18 months (IQR: 13.5-81 months). The median primary patency time for stent placement was 70 months (IQR: 13.5-127.25 months). For balloon angioplasty, the median primary patency time was 9 months (IQR 7.25-11.5 months), while the median assisted primary patency time was 14 months (IQR: 12 to 15 months). Platelet count, spleen size and portal vein flow velocity reliably corresponded to recurrence of portal vein stenosis in asymptomatic patients during follow-up. CONCLUSION Interventional treatment is a safe and efficient method to treat portal vein stenosis with long patency times, regardless of etiology. Primary stent placement shows a higher primary patency time than balloon angioplasty. Implementation of stent placement as the primary interventional method may improve patency times and reduce the need for repeat reinterventions in pediatric patients.
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Affiliation(s)
- Patrick Ghibes
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany.
| | - Gerd Grözinger
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany
| | - Steffen Hartleif
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Ekkehard Sturm
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Gerald M Hefferman
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Ilias Tsiflikas
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany
| | - Jürgen F Schäfer
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany
| | - Christoph Artzner
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany
- Department of Radiology, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
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7
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Natali GL, Cassanelli G, Paolantonio G, Parapatt GK, Gregori LM, Rollo M. Pediatric liver cirrhosis interventional procedures: from biopsy to transjugular intrahepatic portosystemic shunt. Pediatr Radiol 2023; 53:727-738. [PMID: 36121496 PMCID: PMC10027841 DOI: 10.1007/s00247-022-05492-7] [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: 05/02/2022] [Revised: 07/15/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
Cirrhosis is a complex diffuse process whereby the architecture of the liver is replaced by abnormal nodules because of the presence of fibrosis. Several pediatric diseases such as extrahepatic portal vein obstruction, biliary atresia, alpha-1-antitrypsin deficit and autoimmune hepatitis can lead to cirrhosis and portal hypertension in children. In this article the authors describe interventional radiology procedures that can facilitate the diagnosis and treatment of diseases associated with liver cirrhosis and portal hypertension in the pediatric population. These procedures include image-guided liver biopsy, mesenteric-intrahepatic left portal vein shunts, balloon-occluded retrograde transvenous obliteration, transjugular intrahepatic portosystemic shunts and splenic embolization.
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Affiliation(s)
- Gian Luigi Natali
- Interventional Radiology Unit in Oncohematology, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
| | - Giulia Cassanelli
- Interventional Radiology Unit in Oncohematology, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy
| | | | | | | | - Massimo Rollo
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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8
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Hakoda H, Akamatsu N, Shibata E, Takao H, Ichida A, Kawaguchi Y, Kaneko J, Abe O, Hasegawa K. Interventional treatment for portal vein complications utilizing a hybrid operating room after liver transplantation. HPB (Oxford) 2023; 25:589-592. [PMID: 36822928 DOI: 10.1016/j.hpb.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Vascular complications after liver transplantation (LT) can be lethal and require immediate treatment to prevent graft failure. Nowadays, with interventional radiology (IR), approaches such as the percutaneous transhepatic (PTH) and transileocolic venous (TIC), have become major treatment options. We reviewed the safety and efficacy of a hybrid operating room (OR) for portal vein complications after LT. METHODS Patients who underwent IR for post-LT vascular complications in the hybrid OR from May 2014 to May 2022 were enrolled. Patients who underwent post-LT IR in conventional angiography rooms were excluded. RESULTS Nine patients developed portal vein complications; eight after living donor LT and one after deceased donor LT. Six patients had portal vein stenosis, two had portal vein thrombosis, and one had both. In the hybrid OR, PTH and TIC were used in five and three cases, respectively. The Rendezvous technique was used in one case. Angioplasty was performed in all patients. A stent was placed in four patients. The portal venous pressure gradient across the stenotic site significantly decreased after IR (P &= 0.031). The IR success rate in the hybrid OR was 100%. CONCLUSION The hybrid OR enables us to accomplish IR for post-LT vascular complications safely and effectively.
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Affiliation(s)
- Hiroyuki Hakoda
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eisuke Shibata
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidemasa Takao
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiko Ichida
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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9
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Percutaneous Direct Puncture of Retropancreatic Splenic Vein and Portal Thrombectomy in a Patient With Liver Transplantation and Simultaneous Splenectomy. Transplant Direct 2022; 9:e1425. [DOI: 10.1097/txd.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
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Marra P, Dulcetta L, Carbone FS, Muglia R, Muscogiuri G, Cheli M, D’Antiga L, Colledan M, Fagiuoli S, Sironi S. The Role of Imaging in Portal Vein Thrombosis: From the Diagnosis to the Interventional Radiological Management. Diagnostics (Basel) 2022; 12:2628. [PMID: 36359472 PMCID: PMC9689990 DOI: 10.3390/diagnostics12112628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 08/30/2023] Open
Abstract
PURPOSE To illustrate diagnostic and interventional imaging for the characterization and treatment of portal vein thrombosis (PVT). INTRODUCTION The broad spectrum of congenital and acquired PVT manifestations is illustrated, with a focus on the pediatric population; diagnostic and interventional imaging techniques are described. DESCRIPTION PVT frequently presents as an incidental finding at imaging in the screening for liver diseases or for other unrelated reasons. PVT can be classified based on: extension (intrahepatic, extrahepatic, involving the spleno-mesenteric tract, etc.); degree (partial or complete); onset (acute or chronic); and with or without cavernomatous transformation. This comprehensive review relies on the experience gained from a large series of congenital and acquired PVT in a referral center for pediatric and adult liver transplantation. Diagnostic and interventional imaging techniques are described, including: color-Doppler and contrast-enhanced Ultrasound; CT and MR angiography; retrograde portography; percutaneous transhepatic, transplenic, and transmesenteric portography; transjugular intrahepatic portosystemic shunt creation. Pre- and post-operative imaging assessment of the surgical meso-rex bypass is discussed. The description is enriched with an original series of pictorial imaging findings. CONCLUSION PVT is a clinical condition associated with significant morbidity and mortality. Diagnostic and interventional imaging plays a crucial role in both conservative and operative management.
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Affiliation(s)
- Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Maurizio Cheli
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Lorenzo D’Antiga
- Department of Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Stefano Fagiuoli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Gastroenterology, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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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.
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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
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12
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Wei B, Huang Z, Tang C. Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein. Front Med (Lausanne) 2022; 9:853138. [PMID: 35402447 PMCID: PMC8987530 DOI: 10.3389/fmed.2022.853138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 01/10/2023] Open
Abstract
Cavernous transformation of the portal vein (CTPV) is a sequela of extrahepatic and/or intrahepatic portal vein obstruction caused by a combination of local and risk factors. It was ever taken as a relatively rare disease due to its scant literature, which was mainly based on clinical series and case reports. CTPV often manifests as gastroesophageal variceal bleeding, splenomegaly, and portal biliopathy after the long-term insidious presentation. It is unable for CTPV to be recanalized with anticoagulation because it is a complete obstruction of the mesentericoportal axis. Endoscopic therapy is mainly used for temporary hemostasis in acute variceal bleeding. Meso-Rex shunting characterized by portal-flow-preserving shunts has been widely performed in children with CTPV. The multitude of complications associated with CTPV in adults can be effectively addressed by various interventional vascular therapies. With the ubiquity of radiological examinations, optimal treatment for patients with CTPV becomes important. Multivisceral transplantation, such as liver-small intestinal transplantation, may be lifesaving and should be considered for patients with diffuse mesenteric venous thrombosis.
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Affiliation(s)
- Bo Wei
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyin Huang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Chengwei Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Chengwei Tang
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13
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Portal vein obstruction after pediatric liver transplantation: A systematic review of current treatment strategies. Transplant Rev (Orlando) 2021; 35:100630. [PMID: 34107368 DOI: 10.1016/j.trre.2021.100630] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Portal vein obstruction (PVO) is a significant vascular complication after liver transplantation (LT) in pediatric patients. Current treatment strategies include percutaneous transluminal angioplasty (PTA), with or without stent placement, mesorex bypass (MRB), splenorenal shunt, mesocaval shunt, endovascular recanalization (EVR), splenic artery embolization and splenectomy. However, specific characteristics of patients undergoing intervention and selection of individual treatment and its efficacy have remained unclear. This review systematically analyzed biochemical and clinical characteristics, selection of treatment, efficacy, and post-procedural complications. METHODS We systematically searched PubMed and Embase between January 1995 and March 2021 for studies on the management of PVO after LT. We analyzed the reports for biochemical and clinical characteristics at the timing of the intervention in different patients, selection of treatment, and reported efficacies. RESULTS We found 22 cohort studies with 362 patients who had the following characteristics: biliary atresia (83%), living-donor LT (85%), thrombocytopenia (73%), splenomegaly (40%), ascites (16%), or gastrointestinal bleeding (26%). The 3-year primary patency of PTA without stent placement was similar to that with stent placement (70%-80% and 43%-94%, respectively). MRB was used as an initial treatment with a 3-year patency of 75% to 100%. One study showed that 5-year primary patency of EVR was 80%. Secondary patency was 90% to 100% after 3 years in all studies with PTA alone, PTA/stent placement, and stent placement alone. CONCLUSION This is the first review of all treatment protocols in PVO after pediatric LT. We showed that an important group of patients has severe symptoms of portal hypertension. Efficacy of all treatment modalities was high in the included studies which make them important modalities for these patients.
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Ko GY, Sung KB, Gwon DI. The Application of Interventional Radiology in Living-Donor Liver Transplantation. Korean J Radiol 2021; 22:1110-1123. [PMID: 33739630 PMCID: PMC8236365 DOI: 10.3348/kjr.2020.0718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 11/14/2020] [Indexed: 01/10/2023] Open
Abstract
Owing to improvements in surgical techniques and medical care, living-donor liver transplantation has become an established treatment modality in patients with end-stage liver disease. However, various vascular or non-vascular complications may occur during or after transplantation. Herein, we review how interventional radiologic techniques can be used to treat these complications.
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Affiliation(s)
- Gi Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Kyu Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Tsukamoto T, Nobori C, Nishiyama T, Kunimoto T, Kaizaki R, Inoue T, Nishiguchi Y. Stent-graft placement for delayed extrahepatic portal hemorrhage after surgical treatment for perihilar cholangiocarcinoma: A case report. Int J Surg Case Rep 2020; 77:519-522. [PMID: 33395836 PMCID: PMC7704364 DOI: 10.1016/j.ijscr.2020.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022] Open
Abstract
Stent-graft placement is a viable option for treatment of portal vein hemorrhage. Postoperative hemorrhage was caused by extrahepatic portal vein pseudoaneurysm formation. Portal vein pseudoaneurysm occurred at the reconstructed portion.
Introduction Potential curative therapy for perihilar cholangiocarcinoma requires extensive surgical treatment, which can still be associated with significant morbidity and mortality. Postoperative hemorrhage from the portal vein is a rare but life-threatening complication. We herein report postoperative hemorrhage from an extrahepatic portal vein pseudoaneurysm successfully treated by stent graft placement late after surgical treatment for perihilar cholangiocarcinoma. Presentation of case An 83-year-old man was referred to our hospital with a chief complaint of jaundice. Based on radiological findings, we diagnosed the patient with hilar cholangiocarcinoma. After endoscopic retrograde biliary drainage, resection of the extrahepatic bile duct combined with extended left hemi-hepatectomy, including the caudate lobe, lymphadenectomy of the hepatoduodenal ligament, partial resection and reconstruction of the portal vein, and right hepaticojejunostomy was performed. Fourteen days postoperatively, bleeding through the abdominal drain around the portal vein was observed. Twenty days postoperatively, abdominal computed tomography revealed a portal vein pseudoaneurysm that had formed at the portion of reconstruction. Therefore, 24 days postoperatively, a stent graft placement of the pseudoaneurysm through the ileocolic vein was performed. Subsequently, the portal vein hemorrhage ceased. Discussion Our present postoperative extrahepatic portal vein hemorrhage case was caused by an extrahepatic portal vein pseudoaneurysm that had formed at the reconstructed portion by erosion due to the chemical effect of the leaking bile and mechanical irritation of the surgical drain adjacent to the portal vein. Conclusion Stent-graft placement is a minimally-invasive, safe, and effective treatment option for hemorrhage from postoperative portal vein pseudoaneurysm.
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Affiliation(s)
- Tadashi Tsukamoto
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan.
| | - Chihoko Nobori
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Tsuyoshi Nishiyama
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Tomohiro Kunimoto
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Ryoji Kaizaki
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Toru Inoue
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Yukio Nishiguchi
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
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16
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Fukuhara S, Ohira M, Chosa K, BaBa Y, Hamaoka M, Tanimine N, Morimoto H, Kuroda S, Tahara H, Ide K, Kobayashi T, Awai K, Ohdan H. Obliteration of a Portosystemic Shunt by Hybrid Interventional Radiology Using a Transmesenteric Approach Under Minilaparotomy After Liver Transplantation: A Case Report. Transplant Proc 2020; 52:2762-2766. [DOI: 10.1016/j.transproceed.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/04/2020] [Indexed: 01/10/2023]
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17
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The devil is in the detail: current management of perioperative surgical complications after liver transplantation. Curr Opin Organ Transplant 2020; 24:138-147. [PMID: 30694994 DOI: 10.1097/mot.0000000000000616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Despite advances in the field, perioperative morbidity is common after liver transplantation. This review examines the current literature to provide up-to-date management of common surgical complications associated with liver transplantation. RECENT FINDINGS Research focuses on problems with anastomoses of the vena cava, portal vein, hepatic artery, and bile ducts. Interventional endoscopic and radiological techniques are used more frequently to avoid reoperation. SUMMARY Advances in the management of perioperative surgical complications have focused on minimally invasive measures that successfully treat technical problems with implantation of liver allografts from both living and deceased donors.
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Yamamoto H, Khorsandi SE, Cortes‐Cerisuelo M, Kawano Y, Dhawan A, McCall J, Vilca‐Melendez H, Rela M, Heaton N. Outcomes of Liver Transplantation in Small Infants. Liver Transpl 2019; 25:1561-1570. [PMID: 31379050 PMCID: PMC6856963 DOI: 10.1002/lt.25619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/14/2019] [Indexed: 12/12/2022]
Abstract
Liver transplantation (LT) for small infants remains challenging because of the demands related to graft selection, surgical technique, and perioperative management. The aim of this study was to evaluate the short-term and longterm outcomes of LT regarding vascular/biliary complications, renal function, growth, and patient/graft survival in infants ≤3 months compared with those of an age between >3 and 6 months at a single transplant center. A total of 64 infants ≤6 months underwent LT and were divided into 2 groups according to age at LT: those of age ≤3 months (range, 6-118 days; XS group, n = 37) and those of age >3 to ≤6 months (range, 124-179 days; S group, n = 27) between 1989 and 2014. Acute liver failure was the main indication for LT in the XS group (n = 31, 84%) versus S (n = 7, 26%). The overall incidence of hepatic artery thrombosis and portal vein thrombosis/stricture were 5.4% and 10.8% in the XS group and 7.4% and 11.1% in the S group, respectively (not significant). The overall incidence of biliary stricture and leakage were 5.4% and 2.7% in the XS group and 3.7% and 3.7% in the S group, respectively (not significant). There was no significant difference between the 2 groups in terms of renal function. No significant difference was found between the 2 groups for each year after LT in terms of height and weight z score. The 1-, 5-, and 10-year patient survival rates were 70.3%, 70.3%, and 70.3% in the XS group compared with 92.6%, 88.9%, and 88.9% in the S group, respectively (not significant). In conclusion, LT for smaller infants has acceptable outcomes despite the challenges of surgical technique, including vascular reconstruction and graft preparation, and perioperative management.
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Affiliation(s)
- Hidekazu Yamamoto
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | - Shirin E. Khorsandi
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | - Miriam Cortes‐Cerisuelo
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | - Yoichi Kawano
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | - Anil Dhawan
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | - John McCall
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | - Hector Vilca‐Melendez
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | - Mohamed Rela
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
| | - Nigel Heaton
- Liver Transplantation, Institute of Liver StudiesKing’s College HospitalLondonUnited Kingdom
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Mamone G, Caruso S, di Francesco F, Miraglia R, de Ville de Goyet J. Unusual venous collateral pathways allow for reperfusion of the intrahepatic portal venous system in children with portal vein thrombosis after split liver transplantation: Clinical relevance and management implications. Pediatr Transplant 2019; 23:e13539. [PMID: 31328843 DOI: 10.1111/petr.13539] [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] [Received: 09/15/2018] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Abstract
PVT is the most frequent vascular complication after LT in small children, and a higher incidence has been observed in those transplanted for biliary atresia or with a LLSG. Thrombosis of the PV causes extrahepatic portal hypertension and is associated with splenomegaly and the development of venous neo-collaterals, including gastro-oesophageal varices and splenorenal shunts. It has also been incidentally suggested in the literature that patients who have had a Roux-en-Y loop for a biliary reconstruction may present with a cavernomatous transformation of the distal portion of the loop. In this study, 13 children with CEPH caused by thrombosis of the PV after LT were analysed. The study evidenced the development of two types of hepatopetal venous networks: (a) a large cavernoma along the Roux loop and around the biliary anastomosis, and (b) a network of neo-collaterals in the gastro-duodeno-pancreatic area that connected to the intrahepatic portal branches directly through the liver capsule. These hepatopetal venous networks between the venous system of the surrounding organs or the omentum and the intrahepatic portal branches can be identified by radiologists. The relevance for the transplanting physician and the transplant surgeon is discussed.
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Affiliation(s)
- Giuseppe Mamone
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Settimo Caruso
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Roberto Miraglia
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Jean de Ville de Goyet
- Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
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