Enlarging vascular stents after pediatric liver transplantation

Tailored techniques of graft outflow vein reconstruction in pediatric liver transplantation at Asan Medical Center

“…Secure graft outflow vein reconstruction is the most important step for successful pediatric LT. Once HVOO occurs, it is difficult to treat it effectively [1][2][3][4] and the sequences of treatment are often intractable. Endovascular stenting in infant patients should be the last life-saving procedure because it can induce stent-associated vascular insufficiency according to physical growth of the recipient from infant to adolescent [5,6].…”

“…Pediat-ric recipients, especially infants, are vulnerable to vascular complications because their graft and recipient vessels are much smaller than those of adult LT. Once graft inflow or outflow vein stenosis occurs, it is difficult to treat it effectively [1][2][3][4]. Insertion of an endovascular stent can be a rescue treatment in pediatric patients, but such a stent may not expand sufficiently during physical growth of the recipient from infant to adolescent [5]. Consequently, endovascular stent-associated vascular insufficiency can lead to retransplantation later [6].…”

Graft outflow vein unification venoplasty with superficial left hepatic vein branch in pediatric living donor liver transplantation using a left lateral section graft

“… 4 - 7 Note that the insertion of a wall stent into the hepatic vein anastomosis is regarded as a life-saving procedure to cope with hepatic vein outflow obstruction with an anticipation of late retransplantation, because such use of a vascular wall stent may not be expanded enough to follow the long-term physical growth timeframe characteristic of a patient from the years of an infant to a forming adolescent. 8 Therefore, it is critical that an evidence-based secure surgical design is essential for hepatic vein reconstruction in pediatric LDLT.…”

Portal vein reconstruction using side-to-side unification technique for infant-to-infant deceased donor whole liver transplantation

“…Secure PV reconstruction should be a high priority so that PV stenting can be avoided, which is quite different from adult LT cases because PV stenting in infants cannot be sufficiently enlarged, although there is some enlargement of the PV stent. 14,15 Finally, PV stenting induces overt PV stenosis when the infant recipients grow up. Indeed, the long-term outcome of percutaneous transhepatic balloon angioplasty is often reported to be favorable in cases of pediatric LDLT.…”