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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

de Magnée, Catherine MD; Bourdeaux, Christophe MD; De Dobbeleer, Florence MD; Janssen, Magdalena RN; Menten, Renaud MD; Clapuyt, Philippe MD; Reding, Raymond MD, PhD

doi: 10.1097/SLA.0b013e3182121eb7
Surgical Technique

Background and Objective: Portal vein (PV) complications are the most frequent vascular complications in pediatric liver transplant (LT). We hypothesized that pre-LT liver hemodynamic parameters and PV reconstruction technique could predict the risk of PV complications post-LT.

Methods: Three hundred seventy-three children had a primary LT. A detailed ultrasound study of the pre-LT native liver hemodynamics was available in 198 cases, with details of PV anastomosis available for 197 of these: end-to-end anastomosis (n = 146, 74%), interposition vein graft technique (n = 28, 14%), or portoplasty (latero-lateral anastomosis of vein graft and recipient PV) (n = 23, 12%).

Results: Overall 5-year patient survival rate was 90%. Among the 198 patients with pre-LT hemodynamic data, 79 (40%) had PV hypoplasia (diameter ≤4 mm), 64 (32%) had a pathological portal flow (nonhepatopetal flow), and 47 (24%) had an arterial resistance index (ARI) ≥1. Abnormal hemodynamics were mostly observed in biliary atresia (BA). Among these 3 parameters, only ARI ≥1 was significantly correlated with a higher rate of PV complications post-LT (P = 0.041). PV complication-free survival at 5 years were 91% for end-to-end anastomosis, 91% for portoplasty, and 62% for interposition vein graft technique (P = 0.002). At multivariate analysis, the use of an interposition vein graft was the only factor to be significantly associated with a higher rate of PV complications post-LT (P = 0.003).

Conclusions: PV hypoplasia with liver hemodynamic disturbances was mainly observed in BA. Hepatic ARI ≥1 might be a good predictor of PV complications post-LT. Latero-lateral portoplasty seemed to provide the best results when end-to-end anastomosis is not feasible.

From the Pediatric Surgery and Transplant Unit, Pediatric Radiology Unit, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.

Reprints: Catherine de Magnée, Pediatric Surgery and Transplant Unit, Cliniques Universitaires Saint-Luc, Av Hippocrate, 10-1200 Brussels, Belgium. E-mail: catherine.demagnee@uclouvain.be.

No sources of support.

All the authors of this manuscript have nothing to disclose.

Presented at the American 2010 Transplant Congress (San Diego, May 1–5, 2010), at the 11th European Congress of Paediatric Surgery (Bern, June 2–5, 2010), and at the 16th Annual Congress of the International Liver Transplantation Society (Hong Kong, June 16–19, 2010).

© 2011 Lippincott Williams & Wilkins, Inc.