Predictors of portal vein complications after pediatric liver transplantation: A German center experience.
liver transplant
pediatric
portal vein stenosis
portal vein thrombosis
risk factors
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
03
03
2022
received:
10
02
2022
accepted:
09
04
2022
pubmed:
24
4
2022
medline:
14
7
2022
entrez:
23
4
2022
Statut:
ppublish
Résumé
Portal vein complications (PVCs) after pediatric liver transplantation (LT) are sometimes asymptomatic, especially in the early phase, and can threaten both the graft and patient's survival. Therefore, the purpose of this study is to analyze the risk factors for portal vein thrombosis (PVT) and portal vein stenosis (PVS) after pediatric LT. All pediatric patients (n = 115) who underwent primary LT at Regensburg University Hospital between January 2010 and April 2017 were included in this study. The pre-, intra-, and postoperative parameters of all patients were retrospectively reviewed and risk factors for both PVT and PVS were analyzed. Of the 115 patients, living donor LT was performed on 57 (49.5%) patients, and biliary atresia was the primary diagnosis in 65 patients (56%). After pediatric LT, 9% of patients developed PVT, and 16.5% developed PVS. Patient weight ≤7 kg [odds ratio (OR) 9.35, 95% confidence interval (CI) 1.03-84.9, p = .04] and GRWR >3% (OR 15.4, 95% CI 1.98-129.5, p = .01) were the independent risk factors for the development of PVT and PVS, respectively upon multivariate analysis. The overall patient survival rates at 1, 3, and 5 years were 91%, 90%, and 89%, respectively, and there was no difference in patient survival among those with and without PVCs. Pediatric patients with body weight <7 kg and/or receiving a graft with GRWR >3% may develop PVCs and so require certain surgical modifications, close follow-up, and prophylactic anticoagulant therapy following transplant.
Sections du résumé
BACKGROUND
Portal vein complications (PVCs) after pediatric liver transplantation (LT) are sometimes asymptomatic, especially in the early phase, and can threaten both the graft and patient's survival. Therefore, the purpose of this study is to analyze the risk factors for portal vein thrombosis (PVT) and portal vein stenosis (PVS) after pediatric LT.
METHODS
All pediatric patients (n = 115) who underwent primary LT at Regensburg University Hospital between January 2010 and April 2017 were included in this study. The pre-, intra-, and postoperative parameters of all patients were retrospectively reviewed and risk factors for both PVT and PVS were analyzed.
RESULTS
Of the 115 patients, living donor LT was performed on 57 (49.5%) patients, and biliary atresia was the primary diagnosis in 65 patients (56%). After pediatric LT, 9% of patients developed PVT, and 16.5% developed PVS. Patient weight ≤7 kg [odds ratio (OR) 9.35, 95% confidence interval (CI) 1.03-84.9, p = .04] and GRWR >3% (OR 15.4, 95% CI 1.98-129.5, p = .01) were the independent risk factors for the development of PVT and PVS, respectively upon multivariate analysis. The overall patient survival rates at 1, 3, and 5 years were 91%, 90%, and 89%, respectively, and there was no difference in patient survival among those with and without PVCs.
CONCLUSIONS
Pediatric patients with body weight <7 kg and/or receiving a graft with GRWR >3% may develop PVCs and so require certain surgical modifications, close follow-up, and prophylactic anticoagulant therapy following transplant.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14298Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Alfares BA, Bokkers RPH, Verkade HJ, et al. Portal vein obstruction after pediatric liver transplantation: a systematic review of current treatment strategies. Transplant Rev. 2021;35(4):100630. 10.1016/j.trre.2021.100630
Patel R, Mahaveer J, Tahir N, et al. Outcomes of percutaneous portal vein intervention in a single UK paediatric liver transplantation programme. Cardiovasc Intervent Radiol. 2018;41(1):96-103. 10.1007/s00270-017-1792-0
Shibasaki S, Taniguchi M, Shimamura T, et al. Risk factors for portal vein complications in pediatric living donor liver transplantation. Clin Transplant. 2010;24(4):550-556.
Jensen MK, Campbell KM, Alonso MH, Nathan JD, Ryckman FC, Tiao GM. Management and long-term consequences of portal vein thrombosis after liver transplantation in children. Liver Transpl. 2013;19(3):315-321.
Orlandini M, Feier FH, Jaeger B, Kieling C, Vieira SG, Zanotelli ML. Frequency of and factors associated with vascular complications after pediatric liver transplantation. J Pediatr (Rio J). 2014;90(2):169-175.
Moon SB, Moon JI, Kwon CHD, et al. Graft rotation and late portal vein complications in pediatric living donor liver transplantation using left-sided grafts: Long-term computed tomography observations. Liver Transpl. 2011;17(6):717-722.
Yin C, Zhu ZJ, Wei L, Sun LY, Zhang HM, Wu HR. Risk factors for portal vein stenosis in pediatric liver transplantation. Clin Transplant. 2020;34(8):e13992. 10.1111/ctr.13992
Uller W, Knoppke B, Schreyer AG, et al. Interventional radiological treatment of perihepatic vascular stenosis or occlusion in pediatric patients after liver transplantation. Cardiovasc Intervent Radiol. 2013;36(6):1562-1571.
Zant R, Melter M, Beck D, Ameres M, Knoppke B, Kunkel J. Glucose metabolism and associated outcome after pediatric liver transplantation. Transplant Proc. 2016;48(8):2709-2713.
Ko GY, Sung KB, Lee S, et al. Stent placement for the treatment of portal vein stenosis or occlusion in pediatric liver transplant recipients. J Vasc Interv Radiol. 2007;18(10):1215-1221. 10.1016/j.jvir.2007.06.029
Neto JS, Fonseca EA, Feier FH, et al. Analysis of factors associated with portal vein thrombosis in pediatric living donor liver transplant recipients. Liver Transpl. 2014;20(10):1157-1167.
Moon JI, Jung GO, Choi GS, et al. Risk factors for portal vein complications after pediatric living donor liver transplantation with left-sided grafts. Transplant Proc. 2010;42(3):871-875.
Gu LH, Fang H, Li FH, Zhang SJ, Han LZ, Li QG. Preoperative hepatic hemodynamics in the prediction of early portal vein thrombosis after liver transplantation in pediatric patients with biliary atresia. Hepatobiliary Pancreat Dis Int. 2015;14(4):380-385.
Gad EH, Abdelsamee MA, Kamel Y. Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (A retrospective cohort study). Ann Med Surg. 2016;8:28-39.
Ueda M, Oike F, Kasahara M, et al. Portal vein complications in pediatric living donor liver transplantation using left-side grafts. Am J Transplant. 2008;8(10):2097-2105.
Pandey Y, Varma S, Chikkala BR, et al. Outcome of pediatric liver transplants in patients with less than 10 kg of body weight is not worse. Exp Clin Transplant. 2020;18(6):707-711.
Hirata Y, Agarwal S, Varma S, et al. Impact of medial reduction of the left lateral segment: a novel technique for living donor liver transplantation for small pediatric recipients. Liver Transpl. 2020;26(11):1534-1538.
Goldaracena N, Echeverri J, Kehar M, et al. Pediatric living donor liver transplantation with large-for-size left lateral segment grafts. Am J Transplant. 2020;20(2):504-512.
Zakaria HM, Alobthani S, Elsarawy A, et al. Large for size in pediatrics liver transplant using left lateral segment grafts: a single center experience. Pediatr Transplant. 2021;25(6):e14044. 10.1111/petr.14044
de Magnée C, Bourdeaux C, de Dobbeleer F, et al. Impact of pre-transplant liver hemodynamics and portal reconstruction techniques on post-transplant portal vein complications in pediatric liver transplantation: a retrospective analysis in 197 recipients. Ann Surg. 2011;254(1):55-61.
Chardot C, Herrera JM, Debray D, et al. Portal vein complications after liver transplantation for biliary atresia. Liver Transpl Surg. 1997;3(4):351-358.
Bezinover D, Deacutis MF, Dalal PG, et al. Perioperative thrombotic complications associated with pediatric liver transplantation: a UNOS database evaluation. HPB. 2019;21(3):370-378.
Cheng YF, Chen CL, Huang TL, et al. Risk factors for intraoperative portal vein thrombosis in pediatric living donor liver transplantation. Clin Transplant. 2004;18(4):390-394.
Suzuki L, de Oliveira IRS, Widman A, et al. Real-time and doppler US after pediatric segmental liver transplantation: I. portal vein stenosis. Pediatr Radiol. 2008;38(4):403-408. 10.1007/s00247-007-0733-5
Gao H, Wang H, Chen G, Yi Z. Intervention therapy for portal vein stenosis/occlusion after pediatric liver transplantation. Ann Transplant. 2017;22:222-229.
Namgoong J-M, Hwang S, Song G-W, et al. Pediatric liver transplantation with hyperreduced left lateral segment graft. Ann Hepatobiliary Pancreat Surg. 2020;24(4):503-512.
Shehata MR, Yagi S, Okamura Y, et al. Pediatric liver transplantation using reduced and hyper-reduced left lateral segment grafts: a 10-year single-center experience. Am J Transplant. 2012;12(12):3406-3413. 10.1111/j.1600-6143.2012.04268.x
Attia MS, Stringer MD, McClean P, Prasad KR. The reduced left lateral segment in pediatric liver transplantation: an alternative to the monosegment graft. Pediatr Transplant. 2008;12(6):696-700. 10.1111/j.1399-3046.2007.00882.x
Alvarez F. Portal vein complications after pediatric liver transplantation. Curr Gastroenterol Rep. 2012;14(3):270-274. 10.1007/s11894-012-0257-5
Diamond IR, Fecteau A, Millis JM, et al. Impact of graft type on outcome in pediatric liver transplantation: a report from studies of pediatric liver transplantation (SPLIT). Ann Surg. 2007;246(2):301-310. 10.1097/SLA.0b013e3180caa415