Risk factors for portal vein complications in pediatric living donor liver transplantation

Shibasaki, Susumu; Taniguchi, Masahiko; Shimamura, Tsuyoshi; Suzuki, Tomomi; Yamashita, Kazuo; Wakayama, Kenji; Hirokata, Gentaro; Ohta, Minoru; Kamiyama, Tetsuo; Matsushita, Michiaki; Furukawa, Hiroyuki; Todo, Satoru

doi:10.1111/j.1399-0012.2009.01123.x

Cited by 32 publications

(35 citation statements)

References 26 publications

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“…There are technical aspects related to the portal reconstruction per se that can increase the incidence of thrombosis: short vascular stumps in LDLT (anastomoses under tension), a size discrepancy between the donor and recipient vascular structures, anastomotic misalignment, stenosis, anastomotic kinks, a low portal flow (<7 cm/s), a small PV (<4 mm), and the use of interposition VGs . PVCs can also be secondary to other technical problems: venous outflow obstructions (increased resistance in the liver), graft compression, pretransplant thrombosis, high hematocrit, high hepatic arterial flow, prior splenectomy, and portosystemic shunts (decreased portal flow) . These are all important points that need attention when pediatric liver transplantation, especially in recipients with low BWs, is being performed.…”

Section: Discussionmentioning

confidence: 99%

“…6,15 PVCs can also be secondary to other technical problems: venous outflow obstructions (increased resistance in the liver), graft compression, pretransplant thrombosis, high hematocrit, high hepatic arterial flow, prior splenectomy, and portosystemic shunts (decreased portal flow). [16][17][18] These are all important points that need attention when pediatric liver transplantation, especially in recipients with low BWs, is being performed. In the series reported by Ueda et al, 5 vascular conduits were used for 29% of the BA cases and for 4% of the cases without BA.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of factors associated with portal vein thrombosis in pediatric living donor liver transplant recipients

et al. 2014

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The technique of vascular reconstruction plays a major role in the outcome of living donor liver transplantation (LDLT). An increased use of vascular grafts (VGs) as replacements for sclerotic portal veins has become a standard technique for our group. The aim of this study was to analyze the factors associated with portal vein thrombosis (PVT) in pediatric LDLT. We performed a retrospective analysis of 486 primary pediatric LDLT procedures performed between October 1995 and May 2013. VGs used for portal reconstruction included living donor inferior mesenteric veins, living donor ovarian veins, recipient internal jugular veins, deceased donor iliac arteries, and deceased donor iliac veins. Thirty-four patients (7.0%) developed PVT. The incidence of PVT dropped from 10.1% to 2%; the overall utilization of VGs increased from 3.5% to 37.1%. In a multivariate analysis, only the use of VGs remained an independent risk factor for the occurrence of PVT (hazard ratio 5 7.2, 95% confidence interval 5 2.8-18.7, P < 0.001). There was no difference in survival rates between patients with PVT and patients without PVT. No patient with PVT underwent retransplantation. In conclusion, the use of VGs was independently associated with the development of PVT. Over time, there was a reduction in the incidence of early PVT in this cohort, and there was a trend toward a reduction in total PVT. The occurrence of isolated PVT in this study was not associated with decreased patient or graft survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of factors associated with portal vein thrombosis in pediatric living donor liver transplant recipients

et al. 2014

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“…In all of the children who survive long‐lasting PVT, CEPH develops over time. The clinical signs mostly include splenomegaly together with hypersplenism, oesophageal varices, and possible bleeding potentially with a portal biliopathy and growth retardation or rarely ascites and lower extremity oedema . Because the curative options are limited and the major clinical complications do not present themselves in the first years after PVT, most patients with CEPH are usually managed conservatively for long periods, and the therapeutic procedures are limited to endoscopic management of the bleedings.…”

Section: Introductionmentioning

confidence: 99%

Unusual venous collateral pathways allow for reperfusion of the intrahepatic portal venous system in children with portal vein thrombosis after split liver transplantation: Clinical relevance and management implications

Mamone

Caruso

Francesco

et al. 2019

Pediatric Transplantation

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PVT is the most frequent vascular complication after LT in small children, and a higher incidence has been observed in those transplanted for biliary atresia or with a LLSG. Thrombosis of the PV causes extrahepatic portal hypertension and is associated with splenomegaly and the development of venous neo‐collaterals, including gastro‐oesophageal varices and splenorenal shunts. It has also been incidentally suggested in the literature that patients who have had a Roux‐en‐Y loop for a biliary reconstruction may present with a cavernomatous transformation of the distal portion of the loop. In this study, 13 children with CEPH caused by thrombosis of the PV after LT were analysed. The study evidenced the development of two types of hepatopetal venous networks: (a) a large cavernoma along the Roux loop and around the biliary anastomosis, and (b) a network of neo‐collaterals in the gastro‐duodeno‐pancreatic area that connected to the intrahepatic portal branches directly through the liver capsule. These hepatopetal venous networks between the venous system of the surrounding organs or the omentum and the intrahepatic portal branches can be identified by radiologists. The relevance for the transplanting physician and the transplant surgeon is discussed.

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“…Many authors have described various techniques of PV reconstruction and treatments for PVCs [2,5,7,9–12]. In our earlier report, we have found that decreased PV flow velocity led to higher risk of early PVC [13,14]. However, there are only few reports concerning the intra‐operative management when suboptimal PV flow is detected immediately after vascular reconstruction during transplantation [2,15].…”

Section: Introductionmentioning

confidence: 99%

Intra-operative management of low portal vein flow in pediatric living donor liver transplantation

Chiang¹,

Chen²,

Wang³

et al. 2012

Transplant International

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Summary For pediatric living donor liver transplantation, portal vein complications cause significant morbidity and graft failure. Routine intra‐operative Doppler ultrasound is performed after graft reperfusion to evaluate the flow of portal vein. This retrospective study reviewed 65 children who had undergone living donor liver transplantation. Seven patients were detected with suboptimal portal vein flow velocity following vascular reconstruction and abdominal closure. They underwent immediate on‐table interventions to improve the portal vein flow. Both surgical and endovascular modalities were employed, namely, graft re‐positioning, collateral shunt ligation, thrombectomy, revision of anastomosis, inferior mesenteric vein cannulation, and endovascular stenting. The ultrasonographic follow‐up assessment for all seven patients demonstrated patent portal vein and satisfactory flow. We reviewed our experience on the different modalities and proposed an approach for our future intra‐operative management to improve portal vein flow at the time of liver transplantation.

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Risk factors for portal vein complications in pediatric living donor liver transplantation

Abstract: PV size strongly influences PV complications. Other factors such as younger age, low portal venous flow, and high hepatic arterial flow may be risk factors for PV complications.

Cited by 32 publications

References 26 publications

Analysis of factors associated with portal vein thrombosis in pediatric living donor liver transplant recipients

Analysis of factors associated with portal vein thrombosis in pediatric living donor liver transplant recipients

Unusual venous collateral pathways allow for reperfusion of the intrahepatic portal venous system in children with portal vein thrombosis after split liver transplantation: Clinical relevance and management implications

Intra-operative management of low portal vein flow in pediatric living donor liver transplantation

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