Intraoperative stent placement for the treatment of acute portal vein complications in pediatric living-donor liver transplantation

Abstract

Background: Pediatric living-donor liver transplantation (LDLT) in low weight recipients remains one of the most complex surgical procedures, with portal vein (PV) complications occurring in up to 19% of cases. So far, the Results: of stent placement in PV steno-occlusive disease have been encouraging showing excellent long term patency rates. However, current experience with pediatric PV stenting is mostly focused on PV abnormalities diagnosed long after the transplant, when the percutaneous approach is feasible. We propose this technique as an effective alternative to prevent the frequent and complex problem of PV steno-occlusive disease in pediatric LDLT. Method: The inferior mesenteric vien (IMV) is punctured with a 18-gauge catheter.With a Seldinger technique, the angiocatheter is exchanged for a 5-F sheath over a hydrophilic guidewire. Next, direct portal venography is performed to assess the portal anatomy and detect alterations such as stenosis, torsion of the PV or spontaneous portosystemic shunts. The choice of stent and its subsequent placement is made on the basis of the diameter and length of the donor’s proximal portal vein. Results: Between June 2006 and June 2017, 173 pediatric liver transplants were performed, of which 64 (36.9%) included living donors. Seven of these patients (10.9%) underwent PV stent placement during the transplant or in the immediate (< 24 hs) postoperative setting period. Mean hospital stay was 39 days (range, 15-93) after LDLT. During the mean imaging follow-up period of 1,313 days (range 399-4,255 days), none of the patients showed PV abnormality and PV stent remained patent throughout the post-transplant course. There were no deaths or graft loses during the follow-up period. Conclusion: Intraoperative stenting through the IMV approach may offer both a high feasibility and satisfactory Results, with the potential for excellent long-term primary patency despite continued growth in children.