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Risk factors for post-operative portal vein stenosis in pediatric liver transplantation: a single center case-control study

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Abstract

Purpose

The incidence of post-transplant poral vein stenosis (PVS) is higher in pediatric liver transplantation, probably resulting from various portal vein (PV) reconstruction methods or other factors.

Methods

332 patients less than 12 years old when receiving liver transplantation (LT) were enrolled in this research. Portal vein reconstruction methods include anastomosis to the left side of the recipient PV trunk (type 1, n = 170), to the recipient left and right PV branch patch (type 2, n = 79), using vein graft interposition (type 3, n = 32), or end-to-end PV anastomosis (type 4, n = 50). The incidence of PVS was analyzed in terms to different PV reconstruction methods and other possible risk factors.

Results

PVS occurred in 35 (10.5%) patients. Of the 32 patients using vein graft, 20 patients received a cryopreserved vein graft, 11 (55%) developed PVS, while the remaining 12 patients received a fresh iliac vein for PV interposition and none of them developed PVS. 9 patients whose liver donor was under 12 years old developed PVS, with an incidence of 18.8%.

Conclusion

Cryopreserved vein graft interposition and a liver donor under 12 are independent risk factors for PVS in pediatric LT.

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Abbreviations

BA:

biliary atresia

CI:

confidence interval

CIT:

cold ischemic time

CT:

computed tomography

DDLT:

deceased donor liver transplantation

FFP:

fresh frozen plasma

GRWR:

graft to recipient weight ratio

LDLT:

living donor liver transplantation

LLS:

left lateral segment

LT:

liver transplantation

PELD:

Pediatric End-Stage Liver Disease

PFIC:

progressive familial intrahepatic cholestasis

PV:

portal vein

PVS:

poral vein stenosis

RBC:

red blood cell

VG:

vein graft

WIT:

warm ischemic time

References

  1. Stevens JP, Xiang Y, Leong T et al (2022) Portal vein complications and outcomes following pediatric liver transplantation: data from the Society of Pediatric Liver Transplantation. Liver Transpl 28:1196–1206. https://doi.org/10.1002/lt.26412

    Article  PubMed  Google Scholar 

  2. Karakayali H, Sevmis S, Boyvat F et al (2011) Diagnosis and treatment of late-onset portal vein stenosis after pediatric living-donor liver transplantation. Transpl Proc 43:601–604. https://doi.org/10.1016/j.transproceed.2011.01.010

    Article  CAS  Google Scholar 

  3. Gad EH, Abdelsamee MA, Kamel Y (2016) 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 (Lond) 8:28–39. https://doi.org/10.1016/j.amsu.2016.04.021

    Article  PubMed  Google Scholar 

  4. Alvarez F (2012) Portal vein complications after pediatric liver transplantation. Curr Gastroenterol Rep 14:270–274. https://doi.org/10.1007/s11894-012-0257-5

    Article  PubMed  Google Scholar 

  5. Hsu HW, Huang TL, Cheng YF (2016) Sonographic Evaluation of Post-transplantation Portal Vein Stenosis in Pediatric living-donor liver transplant recipients with left-liver grafts. Transpl Proc 48:1162–1165. https://doi.org/10.1016/j.transproceed.2015.12.061

    Article  Google Scholar 

  6. Bukova M, Funken D, Pfister ED (2022) Long-term outcome of primary percutaneous stent angioplasty for pediatric posttransplantation portal vein stenosis. Liver Transpl 28:1463–1474. https://doi.org/10.1002/lt.26488

    Article  PubMed  Google Scholar 

  7. Huang TL, Chen TY, Tsang LL (2012) Hemodynamics of portal venous stenosis before and after treatment in pediatric liver transplantation: evaluation with doppler ultrasound. Transpl Proc 44:481–483. https://doi.org/10.1016/j.transproceed.2012.01.047

    Article  CAS  Google Scholar 

  8. Sakamoto S, Sasaki K, Kitajima T (2018) A novel technique for collateral interruption to maximize portal venous flow in pediatric liver transplantation. Liver Transpl 24:969–973. https://doi.org/10.1002/lt.25016

    Article  PubMed  Google Scholar 

  9. Hwang S, Kim DY, Ahn CS (2013) Computational simulation-based vessel interposition reconstruction technique for portal vein hypoplasia in pediatric liver transplantation. Transpl Proc 45:255–258. https://doi.org/10.1016/j.transproceed.2012.05.090

    Article  CAS  Google Scholar 

  10. Sakamoto S, Uchida H, Kitajima T (2020) The outcomes of Portal Vein Reconstruction with Vein Graft Interposition in Pediatric Liver transplantation for small children with biliary atresia. Transplantation 104:90–96. https://doi.org/10.1097/TP.0000000000002793

    Article  PubMed  Google Scholar 

  11. de Magnee C, Bourdeaux C, De Dobbeleer F (2011) 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 254:55–61. https://doi.org/10.1097/SLA.0b013e3182121eb7

    Article  PubMed  Google Scholar 

  12. Yin C, Zhu ZJ, Wei L (2020) Risk factors for portal vein stenosis in pediatric liver transplantation. Clin Transpl 34:e13992. https://doi.org/10.1111/ctr.13992

    Article  Google Scholar 

  13. Buell JF, Funaki B, Cronin DC (2002) Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg 236:658–666. https://doi.org/10.1097/00000658-200211000-00017

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kyoden Y, Tamura S, Sugawara Y et al (2008) Portal vein complications after adult-to-adult living donor liver transplantation. Transpl Int 21:1136–1144. https://doi.org/10.1111/j.1432-2277.2008.00752.x

    Article  PubMed  Google Scholar 

  15. Kyaw L, Lai NM, Iyer SG (2022) Percutaneous transhepatic interventional therapy of portal vein stenosis in paediatric liver transplantation: a systematic review of efficacy and safety. Pediatr Transpl 26:e14187. https://doi.org/10.1111/petr.14187

    Article  Google Scholar 

  16. Ueno T, Toyama C, Deguchi K (2022) Long-term outcome of Portal Vein Stenting after Pediatric Living Donor Liver Transplantation. Transpl Proc 54:454–456. https://doi.org/10.1016/j.transproceed.2022.01.008

    Article  Google Scholar 

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Funding

This work was supported by the Provincial Key Research and Development Program of Zhejiang (2019C03019).

Author information

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Yigang Qian, Wei Zhang, Weili Wang, Zhiwei Li, Yi Shao, Shunliang Gao, Jian Wu, Jun Yu, Min Zhang, Yan Shen, Xueli Bai & Tingbo Liang

  2. Liver Transplant Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Yigang Qian, Wei Zhang, Weili Wang, Zhiwei Li, Yi Shao, Shunliang Gao, Jian Wu, Jun Yu, Min Zhang, Yan Shen, Xueli Bai & Tingbo Liang

  3. Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Tingbo Liang

  4. Key Lab of Combined Multi-organ Transplantation of the Ministry of Health, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qinchun Road, Hangzhou, China

    Tingbo Liang

Authors
  1. Yigang Qian
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  2. Wei Zhang
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  3. Weili Wang
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  8. Jun Yu
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  9. Min Zhang
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  10. Yan Shen
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  11. Xueli Bai
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  12. Tingbo Liang
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Contributions

T.L. and Y.Q. designed the study. W.Z., Z.L., J.W. and J.Y. collected the clinical data. W.W., S.G. analyzed and interpreted the data. Y.S. prepared Figs. 1 and 2. M.Z. and Y.S. prepared Tables 1, 2, 3, 4 and 5. Y.Q. and X.B. wrote the main manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Tingbo Liang.

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The authors declare no competing interests.

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Qian, Y., Zhang, W., Wang, W. et al. Risk factors for post-operative portal vein stenosis in pediatric liver transplantation: a single center case-control study. Pediatr Surg Int 40, 113 (2024). https://doi.org/10.1007/s00383-024-05690-4

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