04:03 PM Abstract No. 255 Venoplasty of the inferior vena cava in the pediatric liver transplant population can treat a variety of symptoms related to graft failure

Abstract

To evaluate the efficacy of percutaneous venoplasty of a stenosed inferior vena cava (IVC) in the pediatric liver transplant population to avoid a variety of symptoms related to liver graft dysfunction. Using an internal database, we reviewed all pediatric liver transplant cases from March 2014 to August 2018 which underwent percutaneous venoplasty for post-transplant IVC stenosis. Patient demographics, symptoms related to IVC stenosis, pre-venoplasty and post-venoplasty pressure gradients, technical and clinical success, and need for repeat procedure were documented. Eight patients ranging from 8 months to 15 years old underwent a total of 13 IVC venoplasties post-liver transplant with mean follow-up of 18 months. Indications for venoplasty included failure to thrive (n=1), variceal bleeding (n=4), hypoalbuminemia (n=2), and splenomegaly/thrombocytopenia (n=1). Repeat venoplasty was performed in 4 (50%) patients, and one patient required a third venoplasty due to symptom reoccurrence. Average repeat venoplasty was performed 14 months apart. Technical success was 11/13 (85%) with failures due to inability to cross a totally occluded IVC. Average right atrial to IVC pressure gradient was 5.3 mm Hg pre-venoplasty and 3.4 mm Hg post-venoplasty. All 4 patients with variceal bleeding demonstrated an average of 14 months of symptom free follow up post-venoplasty. Single patient with failure to thrive who received portal and IVC venoplasty demonstrated improved appetite on 3-month follow-up. Two patients with hypoproteinemia demonstrated total protein increase from 6.1 to 7.2 gm/dL and total albumin increase from 3.2 to 4.1 gm/dL post-venoplasty. One patient who received venoplasty for splenomegaly/thrombocytopenia demonstrated platelet increase from 125 to 262 k/uL on 6-week follow-up. No clinically significant complication was encountered immediately post-venoplasty or during the follow-up interval. Percutaneous venoplasty of a stenosed IVC post-liver transplant is a safe and effective procedure in the pediatric liver transplant population and can treat symptoms related to graft failure including variceal bleeding, hypoproteinemia, and thrombocytopenia.