Vascular Complications After Liver Transplantation in Pediatric Patients

KEYWORDSSplit liver; Pediatric liver transplantation; Complications; Contrast-enhanced sonography.Abstract Purpose: To evaluate the utility of contrast-enhanced sonography in the study of pediatric liver transplant recipients and its potential impact in reducing the need for invasive diagnostic procedures. Materials and methods: From October 2002 to December 2003 we performed routine color Doppler ultrasound and contrast-enhanced ultrasound studies on 30 pediatric patients who had undergone liver transplantation. Findings indicative of complications were confirmed with invasive studies (angiography, computed tomography, and PTC). Results: Contrast-enhanced sonography correctly identified four of the five cases of hepatic artery thrombosis and all those involving the portal (n Z 6) and hepatic vein (n Z 3) thrombosis. It failed to identify one case of hepatic artery thrombosis characterized by collateral circulation arising from the phrenic artery and the single case of hepatic artery stenosis. The latter was more evident on color Doppler, which revealed a typical tardus parvus waveform. The use of contrast offered no significant advantages in the study of biliary complications although it did provide better visualization of bile leaks. Conclusions: Contrast-enhanced sonography improves diagnostic confidence and reduces the need for more invasive imaging studies in the postoperative follow-up of pediatric liver transplant recipients.Sommario Scopo: Valutare l'utilità dell'ecografia con mezzo di contrasto (Mdc) ecografico di II generazione nel paziente pediatrico trapiantato di fegato, in particolare al fine di ridurre il ricorso a metodiche diagnostiche invasive. ha fornito dati falsamente negativi in un caso di trombosi dell'arteria epatica, ricanalizzata da rami provenienti dall'arteria frenica, e nell'unico caso di stenosi anastomotica dell'arteria epatica della nostra casistica, nel quale è stato indicativo il pattern ''tardus parvus'' osservato all'esame eco-Doppler. Nel caso delle complicanze biliari l'esame eco-contrastografico non ha apportato significativi vantaggi, se non una migliore definizione dei margini e dell'estensione delle raccolte biliari post-intervento. Conclusioni: L'esame ecografico con Mdc è metodica in grado di incrementare la confidenza diagnostica dell'operatore, consentendo una riduzione al ricorso ad esami radiologici invasivi; ciò è particolarmente importante nel caso di pazienti a rischio, quali i bambini sottoposti a trapianto epatico. ª 2007 Published by Elsevier Masson.

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“…They should be suspected when the patient presents signs of liver failure, bile leakage, abdominal hemorrhage, or septicemia [6,7].…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Bonini

Pezzotta

Morzenti

et al. 2007

Journal of Ultrasound

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“…Problems originating from PV were the most common vascular problems (thrombosis in six and stenosis in six) in our series (12/75, 16%). The incidence of PV thrombosis in children has been reported to be between 0% and 33%, and is usually reported more than adult recipients (6, 11). Incidence of PV thrombosis was six of 69 (8.7%) in our series.…”

Section: Discussionmentioning

confidence: 99%

Vascular complications in living‐related and deceased donation pediatric liver transplantation: Single center's experience from Turkey

Yılmaz

Arıkan²,

Tümgör³

et al. 2006

Pediatric Transplantation

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The aim of the study was to assess early and long-term incidence of venous complications, in both deceased donation (DD) and living-related (LR) liver transplantation (LT) in a pediatric population. Seventy-five liver transplants performed in 69 (39 boys, 30 girls) children at Ege University Hospital between 1997 and 2004 were prospectively monitored and reviewed. Age, sex, primary diagnosis, graft type, vascular complications and their management were evaluated. All patients received Doppler ultrasonographic examination both during operation and daily for the first three postoperative days and when necessary thereafter. The complications were classified as early and late presented. Thirty-three grafts (47.8%) were from DD and 36 (52.2%) were from LR donors. Recipients of DD were older than LR donors (mean age 10.5 +/- 5.1 and 5.0 +/- 0.7, respectively) (p < 0.05). Vascular complication occurrence was not statistically different between DDLT and LRLT recipients (p = 0.2), and between infants and children (p = 0.9). Overall, stenosis was more common than thrombosis. We observed hepatic artery (HA) thrombosis, in five of 75 (6.7%) transplants within 30 days post-transplant. Portal vein (PV) thrombosis and hepatic vein (HV) thrombosis were detected in six and one patients (8.7% and 1.3%), respectively. Six PV stenosis were identified (8.7%), while HA and HV-VC (vena cava) stenosis occurred in one and six patients (1.4% and 8.7%), respectively. All PV stenosis (6/33, 18.2%) and one PV aneurysm occurred in DDLT recipients while HV-VC stenosis were detected almost equally in LRLT and DDLT recipients (4/36 vs. 2/33). Except one, all PV stenosis were detected as a late complication and no intervention were needed. Stenosis of HV-VC was more common in girls (5/30 vs. 1/39) (p < 0.05) and the incidence was not different in DDLT and LRLT recipients (p = 0.8). In conclusion, overall incidences of thrombosis and stenosis formation after orthotopic liver transplantation (OLT) were 17.4% and 18.8%, respectively in our center. We suggest that in the cases with HA thrombosis manifested intra-operatively or within the early postoperative period, graft salvage was successful. Thrombosis of HA causes significant mortality. Thrombosis of PV was among the causes of mortality and morbidity. Stenosis of HV-VC could be managed by angioplasty and endovascular stenting with no significant effect to mortality.

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“…If these signs and symptoms are caught early, medical and procedural interventions may be used to ameliorate the effects of HAT, including the use of systemic heparin anticoagulation, surgical thrombectomy, and reconstruction of the arterial anastomosis [6][7][8]. However, if HAT is recognized within the first week of transplant and interventions fail, the patient can be listed for urgent retransplantation [7,[9][10]. Although the incidence, etiology, and management of HAT have been evaluated in a variety of studies, none have investigated the underlying diagnosis leading to transplantation and its possible role in the pathogenesis of this disease.…”

Section: Introductionmentioning

confidence: 99%

Hepatic artery thrombosis and liver malignancy in pediatric liver transplantation

Sanchez

Javid

Lao

et al. 2012

Journal of Pediatric Surgery

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Vascular Complications After Liver Transplantation in Pediatric Patients

Cited by 44 publications

References 10 publications

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Contrast-enhanced ultrasound with SonoVue in the evaluation of postoperative complications in pediatric liver transplant recipients

Vascular complications in living‐related and deceased donation pediatric liver transplantation: Single center's experience from Turkey

Hepatic artery thrombosis and liver malignancy in pediatric liver transplantation

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