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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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Kyaw L, Lai NM, Iyer SG, Loh DSKL, Loh SEK, Mali VP. Percutaneous transhepatic interventional therapy of portal vein stenosis in paediatric liver transplantation: A systematic review of efficacy and safety. Pediatr Transplant 2022; 26:e14187. [PMID: 34724594 DOI: 10.1111/petr.14187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/01/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF THE SYSTEMATIC REVIEW To determine the efficacy and safety of percutaneous trans-hepatic balloon and/or stent angioplasty (PTA) in the management of portal vein (PV) stenosis following paediatric liver transplantation. METHODS Articles were included from a systematic search of Medline, Embase, Cochrane CENTRAL, ClinicalTrials.gov and International Clinical Trials Registry from inception to the 29th of August 2020. RESULTS There were 213 paediatric liver recipients who underwent PTA for PV stenosis in 19 included studies published between 1991 and 2019. Balloon angioplasty was the initial treatment in the majority (n = 153). Primary stent placement (n = 34) was performed for elastic recoil, intimal tears and PV kinks and rescue stent placement (n = 14) for recurrent PV stenosis following primary balloon angioplasty. The technical success was 97.6%-100% overall, 97.6%-100% for balloon-angioplasty-only and 100% for primary stenting. The clinical success was 50%-100% overall, 50%-100% for balloon-angioplasty-only and 100% for primary stenting. Long-term PV patency was 50%-100% overall, 37.5%-100% for balloon-angioplasty-only and 100% for primary stenting. Primary balloon angioplasty was successful in 78% of the cases. Of the recurrent PV stenoses, 9% resolved with stent placement and one required a meso-Rex shunt. There was one re-transplantation without stenting. The complication rate was 2.6% for balloon-angioplasty-only (bleeding, liver abscess, 2 PV thromboses) and 5.9% for primary stenting (bleeding, stent-fracture). There was no procedure-related mortality. CONCLUSION Percutaneous transhepatic balloon angioplasty may be the initial management of portal vein stenosis in paediatric liver recipients. Stent placement may be a primary option in selected cases and a reliable rescue option for recurrent portal vein stenosis following balloon-angioplasty-only.
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Affiliation(s)
- Lin Kyaw
- Department of Paediatric Surgery, National University Hospital, Singapore City, Singapore
| | - Nai Ming Lai
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Shridhar Ganpati Iyer
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore City, Singapore
| | | | - Stanley Eu Kuang Loh
- Department of Diagnostic Imaging, National University Health System, Singapore City, Singapore
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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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Tokunaga K, Furuta A, Isoda H, Uemoto S, Togashi K. Feasibility and mid- to long-term results of endovascular treatment for portal vein thrombosis after living-donor liver transplantation. Diagn Interv Radiol 2020; 27:65-71. [PMID: 33252338 DOI: 10.5152/dir.2020.19469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE We aimed to evaluate mid- to long-term results of endovascular treatment for portal vein thrombosis (PVT) after living-donor liver transplantation (LDLT). METHODS Thirty cases (14 males, 16 females; age range, 0.67-65 years) who underwent endovascular treatment including thrombolysis, angioplasty, stent placement, and/or collateral embolization for PVT after LDLT from 2001 to 2017 were retrospectively reviewed. Clinical and procedural data were collected and analyzed regarding the patency of the PVT site at the last follow-up date (PVT-free persistency) using Log-rank test. Results were considered statistically significant at P < 0.05. RESULTS Median follow-up was 120 months. The technical success rate was 80% (n=24). Patency rates at 1 week and 1, 3, 6, 12, 36, and 60 months were 73%, 59%, 55%, 51%, 51%, 51%, and 51% for primary patency and 80%, 70%, 66%, 66%, 66%, 61%, and 61% for assisted patency after secondary endovascular treatment. PVT-free persistency rates regarding the subgroups were as follows: children under 12 years vs. adults, 50% vs. 68% (P = 0.42); acute vs. nonacute, 76% vs. 46% (P = 0.10); localized vs. extensive, 90% vs. 50% (P = 0.035); transileocolic approach vs. percutaneous-transhepatic approach, 71% vs. 54% (P = 0.39); and thrombolysis-based treatment vs. non-thrombolysis-based treatment, 71% vs. 44% (P = 0.12), respectively. Among technically successful cases, PVT-free persistency rate was 94% for those with hepatopetal flow in the peripheral portal vein vs. 17% for those without hepatopetal flow (P < 0.001). The only major complication occurring was pleural hemorrhage (n=1). Minor complications (i.e., fever) occurred in 18 patients (60%). CONCLUSION In conclusion, mid- to long-term portal patency following endovascular treatment was approximately 50%-60% in PVT patients after LDLT. PVT site patency over three months after the first endovascular treatment, localized PVT, and hepatopetal flow in the peripheral portal vein were identified as key prognostic factors for mid- to long-term portal patency.
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Affiliation(s)
- Koji Tokunaga
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
| | - Akihiro Furuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Transplantation, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Japan
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Ohgi K, Sugiura T, Yamamoto Y, Okamura Y, Ito T, Ashida R, Aramaki T, Uesaka K. Benign Portal Vein Stenosis After Pancreaticoduodenectomy. World J Surg 2019; 43:2623-2630. [PMID: 31243526 DOI: 10.1007/s00268-019-05070-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The long-term patency of the portal vein (PV) in patients who survive after pancreaticoduodenectomy (PD) remains unclear. The aim of the present study was to investigate the clinical features and risk factors for benign PV stenosis after PD. METHODS We retrospectively analyzed the patients who underwent PD from September 2002 and December 2015 at our institution without intraoperative radiation therapy or concomitant PV resection. The postoperative computed tomography of each patient was evaluated, and PV stenosis was defined as the shortest diameter of the PV being <3 mm. The patients with PV stenosis due to local recurrence were excluded. RESULTS Of the 458 patients, PV stenosis occurred in 57 (12.4%), including benign PV stenosis in 28 (6.1%) and PV stenosis due to local recurrence in 29 (6.3%). Of the 28 patients with benign PV stenosis, 7 (25%) developed symptoms related to portal hypertension, namely recurrent gastrointestinal bleeding in 5 and refractory ascites in 2. Six patients were treated with percutaneous transhepatic PV stent placement, and all of their symptoms improved. A multivariate analysis found that a postoperative pancreatic fistula was an independent risk factor for benign PV stenosis after PD (odds ratio, 4.36; p = 0.005). CONCLUSIONS Postoperative pancreatic fistula was a significant risk factor for benign PV stenosis after PD. Stent placement for benign PV stenosis was effective for the patients with symptoms due to portal hypertension.
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Affiliation(s)
- Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Kawano Y, Sanada Y, Urahashi T, Ihara Y, Okada N, Yamada N, Hirata Y, Katano T, Taniai N, Matsuda A, Miyashita M, Yoshida H, Mizuta K. Transition of Spleen Volume Long After Pediatric Living Donor Liver Transplantation for Biliary Atresia. Transplant Proc 2018; 50:2718-2722. [PMID: 30401384 DOI: 10.1016/j.transproceed.2018.03.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/02/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE After undergoing the Kasai procedure for biliary atresia (BA), most patients develop severe splenomegaly that tends to be improved by liver transplantation. However, fluctuations in splenic volume long after transplantation remain to be elucidated. PATIENTS AND METHODS Seventy-one consecutive patients who had undergone pediatric living donor liver transplantation (LDLT) for BA were followed up in our outpatient clinic for 5 years. They were classified into 3 groups according to their clinical outcomes: a good course group (GC, n = 41) who were maintained on only 1 or without an immunosuppressant, a liver dysfunction group (LD, n = 18) who were maintained on 2 or 3 types of immunosuppressants, and a vascular complication group (VC, n = 11). Splenic and hepatic volumes were calculated by computed tomography in 464 examinations and the values compared before and after the treatment, especially in the VC group. RESULTS Splenic volume decreased exponentially in the GC group, with splenic volume to standard spleen volume ratio (SD) being 1.59 (0.33) 5 years after liver transplantation. Splenic volume to standard spleen volume ratios were greater in the VC and LD groups than in the GC group. Patients in the VC group with portal vein stenosis developed liver atrophy and splenomegaly, whereas those with hepatic vein stenosis developed hepatomegaly and splenomegaly. Interventional radiation therapy tended to improve the associated symptoms. CONCLUSIONS Fluctuations in splenic volume long after pediatric LDLT for BA may reflect various clinical conditions. Evaluation of both splenic and hepatic volumes can facilitate understanding clinical conditions following pediatric LDLT.
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Affiliation(s)
- Y Kawano
- Department of Surgery, Nippon Medical School Chiba Hokusou Hospital, Chiba, Japan.
| | - Y Sanada
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - T Urahashi
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - Y Ihara
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - N Okada
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - N Yamada
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - Y Hirata
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - T Katano
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan
| | - N Taniai
- Department of Surgery, Nippon Medical School, Tokyo, Japan
| | - A Matsuda
- Department of Surgery, Nippon Medical School Chiba Hokusou Hospital, Chiba, Japan
| | - M Miyashita
- Department of Surgery, Nippon Medical School Chiba Hokusou Hospital, Chiba, Japan
| | - H Yoshida
- Department of Surgery, Nippon Medical School, Tokyo, Japan
| | - K Mizuta
- Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan
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Sanada Y, Katano T, Hirata Y, Yamada N, Okada N, Ihara Y, Ogaki K, Otomo S, Imai T, Ushijima K, Mizuta K. Interventional radiology treatment for vascular and biliary complications following pediatric living donor liver transplantation - a retrospective study. Transpl Int 2018; 31:1216-1222. [DOI: 10.1111/tri.13285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Yukihiro Sanada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Takumi Katano
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Yuta Hirata
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Naoya Yamada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Noriki Okada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Yoshiyuki Ihara
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
| | - Keiko Ogaki
- Department of Pharmacy; Jichi Medical University Hospital; Shimotsuke Japan
| | - Shinya Otomo
- Department of Pharmacy; Jichi Medical University Hospital; Shimotsuke Japan
| | - Toshimi Imai
- Division of Clinical Pharmacology; Department of Pharmacology; Jichi Medical University; Shimotsuke Japan
| | - Kentraro Ushijima
- Division of Clinical Pharmacology; Department of Pharmacology; Jichi Medical University; Shimotsuke Japan
| | - Koichi Mizuta
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke Japan
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8
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Kawano Y, Murata S, Taniai N, Yoshioka M, Hirakata A, Mizuguchi Y, Shimizu T, Kanda T, Ueda J, Takada H, Yoshida H, Akimaru K, Onozawa S, Kumita S, Uchida E. Interventional Treatment of Severe Portal Vein Thrombosis after Living-Donor Liver Transplantation. J NIPPON MED SCH 2017; 83:206-210. [PMID: 27890896 DOI: 10.1272/jnms.83.206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Portal vein thrombosis (PVT) is a rare complication of liver transplantation which can lead to graft failure and patient death. Treatment can be difficult, especially in cases of PVT from the intrahepatic portal vein to the proximal jejunal veins. A 55-year-old woman had undergone living-donor liver transplantation with splenectomy for end-stage liver cirrhosis due to hepatitis C with hepatocellular carcinoma. Ten months after transplantation, massive ascites and slight abdominal pain developed, and computed tomography revealed a PVT between the intrahepatic portal vein and the superior mesenteric vein. Repeated interventional radiology procedures were used in combination with thrombolysis, thrombectomy, and metallic stent replacement to obtain favorable portal flow to the graft. Five years after being treated, the patient is well, with favorable portal flow having been confirmed. In conclusion, repeated and assiduous interventional radiological treatment combined with thrombolytic therapy, thrombectomy, and metallic stent replacement could be important for severe PVT.
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Affiliation(s)
- Youichi Kawano
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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9
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Bass LM, Kim S, Superina R, Mohammad S. Jejunal varices diagnosed by capsule endoscopy in patients with post-liver transplant portal hypertension. Pediatr Transplant 2017; 21. [PMID: 27762481 DOI: 10.1111/petr.12818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/11/2022]
Abstract
Portal hypertension secondary to portal vein obstruction following liver transplant occurs in 5%-10% of children. Jejunal varices are uncommon in this group. We present a case series of children with significant GI blood loss, negative upper endoscopy, and jejunal varices detected by CE. Case series of patients who had CE for chronic GI blood loss following liver transplantation. Three patients who had their initial transplants at a median age of 7 months were identified at our institution presenting at a median age of 8 years (range 7-16 years) with a median Hgb of 2.8 g/dL (range 1.8-6.8 g/dL). Upper endoscopy was negative for significant esophageal varices, gastric varices, and bleeding portal gastropathy in all three children. All three patients had significant jejunal varices noted on CE in mid-jejunum. Jejunal varices were described as large prominent bluish vessels underneath visualized mucosa, one with evidence of recent bleeding. The results led to venoplasty of the portal vein in two patients and a decompressive shunt in one patient with resolution of GI bleed and anemia. CE is useful to diagnose intestinal varices in children with portal hypertension and GI bleeding following liver transplant.
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Affiliation(s)
- Lee M Bass
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stanley Kim
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Riccardo Superina
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Saeed Mohammad
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gad EH, Abdelsamee MA, Kamel Y. Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (A retrospective cohort study). ANNALS OF MEDICINE AND SURGERY (2012) 2016. [PMID: 27257483 DOI: 10.1016/j.amsu.2016.04.021.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES Hepatic arterial (HA) and portal venous (PV) complications of recipients after living donor liver transplantation(LDLT) result in patient loss. The aim of this study was to analyze these complications. METHODS We retrospectively analyzed HA and/or PV complications in 213 of 222 recipients underwent LDLT in our centre. The overall male/female and adult/pediatric ratios were 183/30 and 186/27 respectively. RESULTS The overall incidence of HA and/or PV complications was 19.7% (n = 42), while adult and pediatric complications were 18.3% (n = 39) and 1.4% (n = 3) respectively. However early (<1month) and late (>1month) complications were 9.4% (n = 20) and 10.3% (n = 22) respectively. Individually HA problems (HA stenosis, HA thrombosis, injury and arterial steal syndrome) 15% (n = 32), PV problems (PV thrombosis and PV stenosis) 2.8% (n = 6) and simultaneous HA and PV problems 1.9% (n = 4). 40/42 of complications were managed by angiography (n = 18), surgery (n = 10) or medically (Anticoagulant and/or thrombolytic) (n = 12) where successful treatment occurred in 18 patients. 13/42 (31%) of patients died as a direct result of these complications. Preoperative PVT was significant predictor of these complications in univariate analysis. The 6-month, 1-, 3-, 5- 7- and 10-year survival rates in patients were 65.3%, 61.5%, 55.9%, 55.4%, 54.5% and 54.5% respectively. CONCLUSION HA and/or PV complications specially early ones lead to significant poor outcome after LDLT, so proper dealing with the risk factors like pre LT PVT (I.e. More intensive anticoagulation therapy) and the effective management of these complications are mandatory for improving outcome.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery and Liver Transplantation, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt
| | | | - Yasmin Kamel
- Anaesthesia, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt
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11
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Gad EH, Abdelsamee MA, Kamel Y. Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (A retrospective cohort study). Ann Med Surg (Lond) 2016; 8:28-39. [PMID: 27257483 PMCID: PMC4878848 DOI: 10.1016/j.amsu.2016.04.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/24/2016] [Indexed: 02/05/2023] Open
Abstract
Objectives Hepatic arterial (HA) and portal venous (PV) complications of recipients after living donor liver transplantation(LDLT) result in patient loss. The aim of this study was to analyze these complications. Methods We retrospectively analyzed HA and/or PV complications in 213 of 222 recipients underwent LDLT in our centre. The overall male/female and adult/pediatric ratios were 183/30 and 186/27 respectively. Results The overall incidence of HA and/or PV complications was 19.7% (n = 42), while adult and pediatric complications were 18.3% (n = 39) and 1.4% (n = 3) respectively. However early (<1month) and late (>1month) complications were 9.4% (n = 20) and 10.3% (n = 22) respectively. Individually HA problems (HA stenosis, HA thrombosis, injury and arterial steal syndrome) 15% (n = 32), PV problems (PV thrombosis and PV stenosis) 2.8% (n = 6) and simultaneous HA and PV problems 1.9% (n = 4). 40/42 of complications were managed by angiography (n = 18), surgery (n = 10) or medically (Anticoagulant and/or thrombolytic) (n = 12) where successful treatment occurred in 18 patients. 13/42 (31%) of patients died as a direct result of these complications. Preoperative PVT was significant predictor of these complications in univariate analysis. The 6-month, 1-, 3-, 5- 7- and 10-year survival rates in patients were 65.3%, 61.5%, 55.9%, 55.4%, 54.5% and 54.5% respectively. Conclusion HA and/or PV complications specially early ones lead to significant poor outcome after LDLT, so proper dealing with the risk factors like pre LT PVT (I.e. More intensive anticoagulation therapy) and the effective management of these complications are mandatory for improving outcome. Preoperative PVT was significant predictor of HA and/or PV complications. HA and/or PV complications especially early ones lead to significant poor outcome. Proper dealing with the risk factors like pre LT PVT improves outcome. The effective management of these complications is mandatory for improving outcome.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery and Liver Transplantation, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt
- Corresponding author.
| | | | - Yasmin Kamel
- Anaesthesia, National Liver Institute, Menoufiya University, Shebein Elkoum, Egypt
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12
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Abstract
BACKGROUND Portal vein (PV) stenosis is a worrisome late complication following pancreaticoduodenectomy (PD) that causes intestinal bleeding from varices, which must be diagnosed correctly and treated promptly. Recent reports advocate the usefulness of stent placement to improve PV stenosis. METHODS We evaluated the cause, diagnosis, and treatment method of PV stenosis after PD and the duration of stent patency in our institution. RESULTS Intestinal bleeding caused by PV stenosis occurred in 5 (2.4%) of 205 patients. A computed tomography scan was useful to diagnose this complication. Four of 5 patients with PV stenosis underwent percutaneous transhepatic PV stent placement. The duration of stent patency was 21-41 months, and no rebleeding occurred. CONCLUSIONS Percutaneous stent placement is viable, less invasive option than laparotomy for the management of PV stenosis after PD.
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Kamran Hejazi Kenari S, Mirzakhani H, Eslami M, Saidi RF. Current state of the art in management of vascular complications after pediatric liver transplantation. Pediatr Transplant 2015; 19:18-26. [PMID: 25425338 DOI: 10.1111/petr.12407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 12/12/2022]
Abstract
Vascular complications by compromising the blood flow to the allograft can have significant and sometimes life-threatening consequences after pediatric liver transplantation. High level of suspicion and aggressive utilization of diagnostic modalities can lead to early diagnosis and salvage of the allograft. This review will summarize the current trends in management of vascular complications after pediatric liver transplantation.
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Affiliation(s)
- Seyed Kamran Hejazi Kenari
- Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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14
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Orlandini M, Feier FH, Jaeger B, Kieling C, Vieira SG, Zanotelli ML. Frequency of and factors associated with vascular complications after pediatric liver transplantation. J Pediatr (Rio J) 2014; 90:169-75. [PMID: 24370174 DOI: 10.1016/j.jped.2013.08.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/19/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE to evaluate the frequency and factors associated with vascular complications after pediatric liver transplantation. METHOD risk factors were evaluated in 99 patients under 18 years of age with chronic liver disease who underwent deceased donor liver transplantation (DDLT) between March of 1995 and November of 2009 at the Hospital de Clínicas de Porto Alegre, Brazil. The variables analyzed included donor and recipient age, gender, and weight; indication for transplant; PELD/MELD scores; technical aspects; postoperative vascular complications; and survival. RESULTS vascular complications occurred in 19 patients (19%). Arterial events were most common, occurred earlier in the postoperative period, and were associated with high graft loss and mortality rates. In the multivariate analysis, the following factors were identified: portal vein diameter ≤ 3mm, donor-to-recipient body weight ratio (DRWR), prolonged ischemic time, and use of arterial grafts. CONCLUSION the choice of treatment depends on the timing of diagnosis; however, in this study, surgical revision or correction produced worse outcomes than percutaneous angioplasty. The reduction of risk factors and early detection of vascular complications are key elements to a successful transplantation.
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Affiliation(s)
- Mariana Orlandini
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flávia Heinz Feier
- Pediatric Liver Transplantation Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Brunna Jaeger
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Carlos Kieling
- Pediatric Hepatology and Liver Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Sandra Gonçalves Vieira
- Pediatric Hepatology and Liver Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Maria Lucia Zanotelli
- Pediatric Liver Transplantation Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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15
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Frequency of and factors associated with vascular complications after pediatric liver transplantation. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2013.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Cho YP, Kim KM, Ha TY, Ko GY, Hwang JY, Park H, Chung YS, Yoon T, Hwang S, Jun H, Kwon TW, Lee SG. Management of late-onset portal vein complications in pediatric living-donor liver transplantation. Pediatr Transplant 2014; 18:64-71. [PMID: 24341631 DOI: 10.1111/petr.12204] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to evaluate retrospectively the results of PTA for late-onset PV complications after pediatric LDLT and to assess whether a meso-Rex shunt is a viable option for treating restenosis of the PV after PTA in selected cases. Seventy-five children who underwent adult-to-child LDLT were included in this study, and there were six late-onset PV complications (8.0%). The initial therapeutic approach was PTA, with or without stent: PTA with balloon dilation for three children, PTA with stent placement for one child, and failure to cannulate the occluded PV for two children. A meso-Rex shunt was performed in the two children after failed PTA: One suffered complete obstruction of the main PV, and the other, restenosis with total thrombosis after PTA with stent. The PTA was a technical and clinical success in four with PV stenosis of the six patients (66.7%), and successful application of a meso-Rex shunt in the other two children resulted in restoration of PV flow. In conclusion, PTA is a safe and effective procedure for treating late-onset PV stenosis after pediatric LDLT. However, in growing pediatric recipients with restenosis of the PV after PTA or chronic PV thrombosis, a meso-Rex shunt may be a better choice for late-onset PV complications.
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Affiliation(s)
- Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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17
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Zhang WG, Liu DM, Li Z, Wang YL, Ding PX, Zhou PL, Wang ZG, Han XW. Endovascular Treatment for Extrahepatic Portal Vein Bifurcation Stenosis after a Whipple Procedure Using the Kissing Stents Technique. Ann Vasc Surg 2014; 28:264.e13-6. [DOI: 10.1016/j.avsg.2013.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/29/2013] [Accepted: 04/07/2013] [Indexed: 10/26/2022]
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18
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Takatsuki M, Soyama A, Muraoka I, Hara T, Kinoshita A, Yamaguchi I, Tanaka T, Kuroki T, Eguchi S. Post-operative complications requiring hospitalization more than one yr after living donor liver transplantation. Clin Transplant 2013; 28:105-10. [DOI: 10.1111/ctr.12287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Mitsuhisa Takatsuki
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Akihiko Soyama
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Izumi Muraoka
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Takanobu Hara
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Ayaka Kinoshita
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Izumi Yamaguchi
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Takayuki Tanaka
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Tamotsu Kuroki
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Susumu Eguchi
- Department of Surgery; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
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19
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Tsuruga Y, Kamachi H, Wakayama K, Kakisaka T, Yokoo H, Kamiyama T, Taketomi A. Portal vein stenosis after pancreatectomy following neoadjuvant chemoradiation therapy for pancreatic cancer. World J Gastroenterol 2013; 19:2569-2573. [PMID: 23674861 PMCID: PMC3646150 DOI: 10.3748/wjg.v19.i16.2569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/01/2013] [Accepted: 03/09/2013] [Indexed: 02/06/2023] Open
Abstract
Extrahepatic portal vein (PV) stenosis has various causes, such as tumor encasement, pancreatitis and as a post-surgical complication. With regard to post-pancreaticoduodenectomy, intraoperative radiation therapy with/without PV resection is reported to be associated with PV stenosis. However, there has been no report of PV stenosis after pancreatectomy following neoadjuvant chemoradiation therapy (NACRT). Here we report the cases of three patients with PV stenosis after pancreatectomy and PV resection following gemcitabine-based NACRT for pancreatic cancer and their successful treatment with stent placement. We have performed NACRT in 18 patients with borderline resectable pancreatic cancer since 2005. Of the 15 patients who completed NACRT, nine had undergone pancreatectomy. Combined portal resection was performed in eight of the nine patients. We report here three patients with PV stenosis, and thus the ratio of post-operative PV stenosis in patients with PV resection following NACRT is 37.5% in this series. We encountered no case of PV stenosis among 22 patients operated with PV resection for pancreatobiliary cancer without NACRT during the same period. A relationship between PV stenosis and NACRT is suspected, but further investigation is required to determine whether NACRT has relevance to PV stenosis.
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20
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Mali V, Aw M, Quak S, Loh D, Prabhakaran K. Vascular Complications in Pediatric Liver Transplantation; Single-Center Experience from Singapore. Transplant Proc 2012; 44:1373-8. [DOI: 10.1016/j.transproceed.2012.01.129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/18/2012] [Indexed: 01/10/2023]
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Schneider N, Scanga A, Stokes L, Perri R. Portal vein stenosis: a rare yet clinically important cause of delayed-onset ascites after adult deceased donor liver transplantation: two case reports. Transplant Proc 2012; 43:3829-34. [PMID: 22172855 DOI: 10.1016/j.transproceed.2011.09.068] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 09/16/2011] [Indexed: 01/10/2023]
Abstract
Vascular complications following liver transplantation are well documented. While complications involving the portal vein are less common than the hepatic artery, portal vein complications can lead to potentially life-threatening sequelae including graft loss. Portal vein stenosis is an infrequent complication following liver transplant. The majority of these complications are seen in living donor liver transplants and pediatric liver transplants. We present 2 cases of delayed onset portal vein stenosis in adult deceased donor liver transplantation (ADDLT). The first patient presented with refractory ascites twelve months after ADDLT. He was diagnosed and successfully treated with percutaneous transhepatic portovenography and venoplasty. The second patient had a history of irradiation to his portal bed in the setting of cholangiocarcinoma. He developed refractory ascites and esophageal variceal bleeding>2 years after ADDLT. He underwent percutaneous transhepatic portovenoplasty, but eventually required placement of a portal stent due to continued problems with recurrent ascites. These 2 cases highlight the importance of considering portal vein stenosis in the differential diagnosis of late-onset ascites following liver transplantation, especially if there have been any predisposing risk factors such as portal bed irradiation or prior splenectomy.
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Affiliation(s)
- N Schneider
- Division of Gastroenterology and Hepatology, Department of Medicine, Vanderbilt University Medical School, Vanderbilt Digestive Disease Center, The Vanderbilt Clinic, Nashville, Tennessee 37232-5280, USA.
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22
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Lin TL, Chiang LW, Chen CL, Wang SH, Lin CC, Liu YW, Yong CC, Lin TS, Li WF, Jawan B, Cheng YF, Chen TY, Concejero AM, Wang CC. Intra-operative management of low portal vein flow in pediatric living donor liver transplantation. Transpl Int 2012; 25:586-91. [PMID: 22448749 DOI: 10.1111/j.1432-2277.2012.01464.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For pediatric living donor liver transplantation, portal vein complications cause significant morbidity and graft failure. Routine intra-operative Doppler ultrasound is performed after graft reperfusion to evaluate the flow of portal vein. This retrospective study reviewed 65 children who had undergone living donor liver transplantation. Seven patients were detected with suboptimal portal vein flow velocity following vascular reconstruction and abdominal closure. They underwent immediate on-table interventions to improve the portal vein flow. Both surgical and endovascular modalities were employed, namely, graft re-positioning, collateral shunt ligation, thrombectomy, revision of anastomosis, inferior mesenteric vein cannulation, and endovascular stenting. The ultrasonographic follow-up assessment for all seven patients demonstrated patent portal vein and satisfactory flow. We reviewed our experience on the different modalities and proposed an approach for our future intra-operative management to improve portal vein flow at the time of liver transplantation.
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Affiliation(s)
- Ting-Lung Lin
- Liver Transplantation Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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23
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Chu J, Kerkar N, Miloh TA, Rodriguez-Laiz G, Lewis B, Stangl A, Newton KP, Iyer K, Arnon R. Roux-en-Y loop varices in children with portal hypertension after liver transplantation: an unusual cause of "obscure" gastrointestinal bleeding. Pediatr Transplant 2011; 15:E156-61. [PMID: 20609173 DOI: 10.1111/j.1399-3046.2010.01351.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PHALT may result from graft dysfunction, portal vein thrombosis, arterio-venous fistulas and can lead to GIB, commonly from bleeding esophageal varices. We present three children with GIB requiring multiple blood transfusions that were diagnosed with RY Loop bleeding. Routine EGD, colonoscopy, and CE failed to reveal the bleeding source. However, enteroscopy revealed large varices at the site of hepaticojejunostomy anastomosis in all. Our experience demonstrates that RY loop varices in children with PHALT are a rare and treatable cause of obscure GI bleeding.
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Affiliation(s)
- Jaime Chu
- Division of Pediatric Hepatology, Mount Sinai Medical Center, New York, NY, USA
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24
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Karakayali H, Sevmis S, Boyvat F, Aktas S, Ozcay F, Moray G, Arslan G, Haberal M. Diagnosis and treatment of late-onset portal vein stenosis after pediatric living-donor liver transplantation. Transplant Proc 2011; 43:601-4. [PMID: 21440774 DOI: 10.1016/j.transproceed.2011.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Portal vein stenosis is a relatively rare complication after living-donor liver transplantation, which sometimes leads to a life-threatening event owing to gastrointestinal bleeding or graft failure. This study sought to evaluate the diagnoses and management of late-onset portal vein stenosis in pediatric living-donor liver transplants. MATERIALS AND METHODS Since September 2001, we performed 123 living-donor liver transplant procedures in 120 children, among which 109 children with a functioning graft at 6 months after living-donor liver transplant are included in this analysis. Seven instances of portal vein stenosis were diagnosed and were analyzed retrospectively. RESULTS The median age of the children was 5.3 years, and the median body weight was 19.2 kg. Portal vein stenosis was diagnosed at 11.2±3.1 months after living-donor liver transplantation. Whereas 3 children were asymptomatic, splenomegaly and/or massive ascites were observed in the remaining 4. Additionally, platelet counts were below the normal limit in 4 children. All children were treated with transhepatic balloon dilatation except 1. Intraluminal stent placement was needed in 1 child owing to resistance of balloon dilatation. The mean pressure gradient decreased from 12.4 to 3.2 mmHg after successful treatment. We did not observe any treatment-related complications. Portal venous patency was maintained in all children during posttreatment follow-up of 43.2±20.4 months. There were no recurrences of portal vein stenosis. One child died; the remaining 6 children are alive with good graft function at 49.8±23.9 months of follow-up. CONCLUSION Although most portal vein stenosis is asymptomatic, splenomegaly and platelet counts are 2 important markers for portal vein stenosis. Early detection of portal vein stenosis with these 2 markers can lead to successful interventional percutaneous approaches and avoid graft loss.
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Affiliation(s)
- H Karakayali
- Department of General Surgery, Başkent University Faculty of Medicine, Ankara, Turkey
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25
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Moon SB, Moon JI, Kwon CHD, Kim SJ, Seo JM, Joh JW, Lee SK. Graft rotation and late portal vein complications in pediatric living donor liver transplantation using left-sided grafts: long-term computed tomography observations. Liver Transpl 2011; 17:717-22. [PMID: 21618693 DOI: 10.1002/lt.22262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Right-side rotation of the graft is an uncommon event after pediatric living donor liver transplantation (LDLT) with a left-sided graft. However, graft rotation might lead to gradual portal vein (PV) stretching and late portal vein complications (PVCs). The goal of this study was to quantify the degree of graft rotation (R) by computed tomography (CT) and to determine the effect of graft rotation on the development of late PVCs. One hundred ten patients underwent LDLT with left-sided grafts between 1996 and 2009; CT images were available and were reviewed for 66 of these patients. To quantify R, the following variables were measured with CT: the longest distance between the midline and the extrahepatic PV at the level of the hepatic hilum (A), the distance between the midline and the center of the superior mesenteric vein at the level of the confluence of the splenic vein and superior mesenteric vein (B), and the inner transverse diameter of the body cavity at the level at which A was measured (C). R was calculated as (A - B)/C. In patients with a patent PV (n = 59) and in patients with late PVCs (n = 7), the median R values were 0.16 (range = 0.03-0.38) and 0.25 (range = 0.13-0.39), respectively; there was a significant difference between the 2 groups (P = 0.003). Multivariate analysis showed that R ≥ 0.2 was the only independent risk factor for the development of late PVCs (P = 0.021). In conclusion, the gradual stretching of the PV after right-side rotation of left-sided grafts might play an important role in the development of late PVCs. PV patency should be closely monitored when graft rotation is noted during clinical follow-up.
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Affiliation(s)
- Suk-Bae Moon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Schulte am Esch J, Akyildiz A, Tustas RY, Ganschow R, Schmelzle M, Krieg A, Robson SC, Topp SA, Rogiers X, Knoefel WT, Fischer L. ADP-dependent platelet function prior to and in the early course of pediatric liver transplantation and persisting thrombocytopenia are positively correlated with ischemia/reperfusion injury. Transpl Int 2010; 23:745-52. [PMID: 20136783 DOI: 10.1111/j.1432-2277.2010.01054.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Little is known about the role of platelets in relation to ischemia/reperfusion injury (IRI) of the liver graft especially in children. Thrombocyte function was prospectively analysed in 21 consecutive pediatric liver transplantation (pLT) patients by platelet aggregometry secondary to adenosine diphosphate (ADP), collagen, and the von Willebrand factor activator ristocetin (VWF:rco). Post-OP serum levels of ALT were used to divide patients into groups with high (highHD, n = 8) and low (lowHD, n = 13) hepatocellular damage. Clinically, highHD-patients showed impaired plasmatic coagulation and elevated serum bilirubin levels early after pLT when compared with lowHD-patients. Further, platelet counts markedly decreased between pre-OP and postreperfusion (postrep.) in the highHD group (P = 0.003) and did not recuperate by POD6. In lowHD individuals thrombocytopenia improved from both pre-OP (P < 0.05) and postrep. (P < 0.001) respectively towards POD6. Experimental thrombocyte testing revealed that before graft reperfusion only ADP-dependent platelet aggregation correlated with reperfusion injury, thrombocytopenia and early graft function. During the first 48 h after graft reperfusion, all inducers tested demonstrated elevated platelet aggregation levels in the highHD group. Our data suggest a possible role of platelets and their aggregative status in liver IRI subsequent to clinical pLT. Reperfusion-independent ADP-triggered platelet function may be a determinant for IRI in the pediatric hepatic graft recipient.
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Affiliation(s)
- Jan Schulte am Esch
- Department of Visceral, General and Pediatric Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.
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