Hepatic Hemodynamics in Cirrhotic Children: Correlation to PELD and Portal Vein Complications After Liver Transplantation.

Abstract

Background Liver hemodynamic (LH) disturbances and portal vein (PV) complications are frequently observed in pediatric liver transplantation (LT). We hypothesized that cirrhosis in children is associated with LH features which could lead to PV complications after LT. Methods We retrospectively analyzed 198 LT recipients (median age: 1.6 year), including 130 biliary atresia (BA). Pre-LT hemodynamics were studied using Doppler ultrasound, and correlated with the incidence of post-LT PV complications. In children with BA-related PV hypoplasia, the technique used for PV reconstruction was correlated with the incidence of post-LT PV complications. Moreover, intraoperative flowmetry of LH was studied prospectively at LT in 31 cirrhotic children (median age: 0.9 year), including 23 BA. Results At retrospective analysis, hepatic arterial resistance index ≥ 1 at pre-LT ultrasound was associated with a higher rate of PV complications (p=0.041). In children with BA-related PV hypoplasia, the portoplasty technique alleviated the extra risk of PV complications (6.2% with portoplasty versus 19.3% without portoplasty). The prospective hemodynamic studies showed that: (1) pediatric cirrhosis was associated with a reduction of pre-LT total liver flow of more than 60% (median: 35 ml/min/100gr of liver), compared to expected values (100 ml/min/100gr); (2) this reduction of total liver flow was correlated with PELD (tau=-0.259; p=0.041). Conclusions Pediatric cirrhosis is associated to severe LH disturbances, which are correlated with PELD. Pre-LT hemodynamic assessment may help to predict, and efficiently manage liver vascular anomalies in pediatric LT, including BA-related PV hypoplasia.