Portal Vein Thrombosis and Stenosis in Pediatric Liver Transplantation1

Abstract

The aim of this study was to determine the outcome of venous conduits used in living donor liver transplantation (LDLT). We analyzed the portal vein complications in 66 LDLT recipients and 48 cadaveric reduced-size liver transplant (RLT) recipients performed from November 1989 through January 1995. Three different venous conduits were utilized in the LDLT recipients: Group 1, reconstructed vein from the living donor, n=18; Group 2, cadaveric cryopreserved iliac vein, n=37; and Group 3, cadaveric cryopreserved femoral vein, n=11. Overall, 47 percent of the patients were less than one year of age; the age distribution was not significantly different among the groups. The incidence of early thrombosis was significantly greater in LDLT Group 1, (33%) than any of the other groups (LDLT Group 2, 8%; LDLT Group 3, 9%; and RLT, 4%:P<0.0005 vs. reduced graft and < 0.03 vs. other LDLT groups). The incidence of late portal vein stenosis or thrombosis was significantly higher in the LDLT Group 2, (51%) than any of the other groups (LDLT 1, 16%; LDLT Group 3, 9%; RLT 4%;P<0.005 vs. cadaveric and < 0.02 vs. LDLT Group 1 and LDLT Group 3). Five year arterial graft and patient survival for patients who have experienced portal vein thrombosis or stenosis is 61% and 67%, respectively, versus 67% and 71% for those patients who have not experienced portal vein pathology, P=ns. Based on this experience, we recommend avoiding the use of cryopreserved iliac vein for portal vein reconstruction in liver transplantation. Every effort should be taken to eliminate the need for venous conduits in liver transplantation. If venous conduits must be utilized, cryopreserved femoral veins seem to provide superior patency rates. Careful clinical and ultrasonopraphic monitoring of patients at high risk for late venous thrombosis permits therapy with excellent graft and patient survival.

Cavoportal transposition for portal vein thrombosis in a pediatric living-related liver transplantation

“…1 It can usually be managed intraoperatively by one of a variety of reconstructive techniques. [1][2][3][4] The choices include thromboendovenectomy, venous jump grafts, and use of collateral veins to revascularize the liver with portal venous blood. In a small proportion of patients, occlusion of the portal, splenic, and superior mesenteric veins may make portal inflow to the graft impossible.…”

Thrombosed Cavo-Portal Hemi-Transposition Salvaged by Digital Subtraction Angiography and Self Expanding Metallic Stent Deployment-Report of First Case and Review of Literature

“…PVT in pediatric LDLT can have multiple etiologies. Some of them are Porto-caval shunts, atretic portal vein, large for size graft, difficult abdominal closure, low perfusion states in the post-operative period and hypercoagulable states [7]. Post LT, PVT is associated with higher mortality rates.…”

Interventional percutaneous trans-splenic approach in the management of portal venous occlusion after living donor liver transplantation

“…Many reports have indicated that there is a high incidence of portal vein complications when venous conduits are used to reconstruct the donor and recipient portal veins. 4,5 The reported incidence of early portal vein thrombosis varies between 0% and 30%, depending on the series selected. [6][7][8][9] Several factors have been implicated, including the portal vein size, type of graft used, and graft positional factors.…”

“…Late portal and hepatic vein stenoses are commonly present with varied clinical signs and syndromes, including new-onset ascites, variceal bleeding, splenomegaly, increases in liver enzymes, lower extremity edema, and renal insufficiency. 4 The diagnosis of portal vein stenosis or thrombosis can be suggested by abdominal ultrasound findings. Confirmation and common therapeutic interventions for all venous stenoses are done by invasive angiography; thus, interventional radiology is essential.…”