Interventional radiology treatment for vascular and biliary complications following pediatric living donor liver transplantation - a retrospective study

Abstract

There are few long-term outcome reports for interventional radiology (IVR) treatments for vascular and biliary complications following pediatric living donor liver transplantation (LDLT). Herein, we presented our institution's experience and investigated the efficacy and issues of long-term outcome with IVR treatments. Between May 2001 and September 2016, 279 pediatric LDLTs were performed. The median age at LDLT was 1.4 years old, and the median observation period was 8.2 years. All the biliary reconstructions at LDLT were hepaticojejunostomy. The IVR treatments were selected as endovascular, radiological, or endoscopic interventions. Post-transplant hepatic vein, portal vein, hepatic artery, and biliary complications were present in 7.9%, 14.0%, 5.4%, and 18.3%, respectively. IVR treatment was the first treatment option in 81.8%, 94.9%, 46.7%, and 94.1%, respectively. The recurrence and cure rates following IVR treatment were 42.1%, 21.1%, 44.4%, and 34.0% and 84.2%, 97.4%, 100%, and 88.0%, respectively. The graft survival rates in patients with and without post-transplant vascular and biliary complications were 94.4% and 90.6%, respectively (P = 0.522). The IVR treatments for vascular and biliary complications following pediatric LDLT are the first choice option. Although the recurrence following IVR treatment is a major problem and it is necessary to carefully perform long-term follow-up, IVR treatments have good treatment outcomes.

Time is of the essence: A single‐center experience of hepatic arterial supply impairment management in pediatric liver transplant recipients

“…So, Sanada et al describe the successful use of interventional radiology treatments for HAT (n = 15) with a 44.4% recurrence rate, but with a 100% cure rate from endovascular interventions. The authors give a median of the total observational period for all types of interventions, which was 8.2 years 35 …”

“…The authors give a median of the total observational period for all types of interventions, which was 8.2 years. 35 We would like to emphasize that all recipients with ITBL should be considered as possible candidates for retransplantation. This concern finds support in the work of Fujiki et al 33 Percutaneous drainage of abscess or biloma and placement of internal-external stent for ischemic strictures may successfully treat moderate ITBL, as demonstrated in our study and elsewhere.…”

The Application of Interventional Radiology in Living-Donor Liver Transplantation

“…Portal vein stenosis (PVS), a complication of the portal vein (PV), is rare in adult DDLT cases; however, it may occur in 2–3% of adult LDLT cases [ 3 4 ] and 8–14% of pediatric LDLT cases [ 5 6 7 8 ]. Technical factors, such as a tight suture line, discrepancy in PV size, tension or torsion of the PV, a redundant PV, or the use of a bypass graft, can contribute to early PVS [ 9 10 ].…”

“…Furthermore, in the later period, intimal hyperplasia or fibrosis around the anastomosis may induce PVS [ 11 ]. Although such complications have traditionally been treated with surgery, interventional techniques, including balloon angioplasty and stent placement, have recently been accepted as the initial treatment of choice [ 4 5 6 9 ].…”

“…Most of the previous data were from DDLT, as LDLT cases were rare [ 6 64 69 ]. In LDLT, the diameters of the HA branches are usually smaller than that in DDLT.…”