Outcomes of Percutaneous Portal Vein Intervention in a Single UK Paediatric Liver Transplantation Programme

Abstract

IntroductionPercutaneous transluminal angioplasty (PTA), with or without stent placement, has become the treatment of choice for portal vein complications (PVC) following liver transplantation. We aimed to assess long-term outcomes of intervention in paediatric transplant recipients, in a single institution.Materials and Methods227 children received 255 transplants between November 2000 and September 2016. 30 patients developed PVC of whom 21 had percutaneous intervention. Retrospective clinical and procedural outcome data on these 21 patients were collected.Results21 patients, with median age 1.7 years (range 0.4–16.2), underwent 42 procedures with PTA with or without stenting. 36 procedures were for PV stenosis and 6 for PV thrombosis. Treatment was with primary PTA, with stenting reserved for suboptimal PTA result or restenosis within 3 months. 28 procedures were performed with PTA and 13 with stenting. Technical success (>50% reduction in mean pressure gradient, absolute pressure gradient ≤4 mmHg or venographic stenosis <30%) was achieved in 41 procedures. Failure to recanalise a thrombosed PV occurred in 1 procedure. There were no major procedural complications. Patients were followed-up with serial Doppler ultrasound surveillance. Kaplan–Meier estimated median primary patency was 9.9 months, with primary-assisted patency of 95% after median follow-up of 45.5 months (range 11.1–171.6).ConclusionWith regular surveillance, excellent patency rates can be achieved following percutaneous intervention for PVC post-paediatric liver transplantation.

Safety and Efficacy of Endovascular Treatment of Portal Vein Stenosis in Liver Transplant Recipients: A Systematic Review

“…Only a few studies in our analysis exclusively reported primary patency for balloon angioplasty and stent placement in a Kaplan Meier format (see Table 4). These studies show that 1, 5 & 10 year primary patency rates of balloon angioplasty 20,23,24 were lower compared to primary stent groups 18,20 that showed 10 year patency at 100%. These results suggest that primary angioplasty is more likely to result in restenosis and require further interventions.…”

Perioperative thrombotic complications associated with pediatric liver transplantation: a UNOS database evaluation

“…9 Fortunately, post-procedure angioplasty has been demonstrated to be effective in reducing the incidence of postoperative PVT. 26 HAT is associated with increased mortality, re-intervention, re-transplantation, and reduced long-term graft survival. 10,11,17,24,25 Although specific types of postoperative thrombotic complications were not defined in the UNOS database, the vast majority of these events in both adults and children are most likely related to HAT.…”

The Application of Interventional Radiology in Living-Donor Liver Transplantation

“…Stents with appropriate lengths to cover the stenosis with minimal angulation relative to the PV should be selected. In pediatrics, a balloon-expanding stent ≥ 7–8mm diameter and a short length is preferred because this type of stent can be positioned accurately, thus minimizing the difficulties of re-transplantation [ 22 23 ]. It can also be re-expanded or overdilated in the future if functional stenosis of the fixed stent occurs [ 24 25 ].…”