Long-term instead of repetitive treatment: benefits of primary stenting for portal vein stenosis in pediatric liver transplantation

Abstract

To the editor,We thank Marra and colleagues for their critical comments on our publication. Their statement reflects the ongoing controversy concerning the best strategy for posttransplant portal vein stenosis in children as long as there are no controlled multi-center data but single-center experiences. Therefore, we look forward to the publication of the PORTAL registry data.As Marra and colleagues pointed out, there are promising data on balloon angioplasty for portal vein stenosis after pediatric liver transplantation. [1,2] There are definitely patients who might be cured with balloon angioplasty alone. However, the cohorts differ substantially. The patients reported by Naik and colleagues were much older than our cohort, with a longer post transplant interval before catheter intervention. The study of Yabuta et al. [2] has been discussed in our manuscript. A substantial number of their patients received multiple reinterventions (25% of their patients with up to 5 procedures!) for long-term portal vein patency. The review of Kyaw et al. [3] stated a recurrence rate of 22% for balloon angioplasty and lower success rates in infants and toddlers.Both Kyaw et al. [3] and Shim et al. [4] concluded that "clinical success and long-term patency were superior in the primary stent group" compared with balloon angioplasty alone.The potential harm of portal vein stents concerning future transplantation and the potential risk of stent migration are traditional surgical arguments against long self-expanding stents used in the 1990s, which can nowadays be avoided using modern stent technology. The technical challenges during potential retransplantation after portal vein stenting should be manageable by an experienced surgical team.Our data have demonstrated that primary stent angioplasty of portal vein stenosis may avoid early restenosis in small children. Potential reinterventions in school-aged children or adolescents to reach adult-size portal vein diameters will be tolerated much better. In our center, we strictly try to avoid multiple invasive procedures needing general anesthesia in small children. Therefore, we aim for the most effective primary treatment option with the lowest recurrence rates for posttransplant portal vein stenosis. CONFLICT OF INTERESTNothing to report.