Abstract
IntroductionPercutaneous transluminal angioplasty (PTA), with or without stent placement, has become the treatment of choice for portal vein complications (PVC) following liver transplantation. We aimed to assess long-term outcomes of intervention in paediatric transplant recipients, in a single institution.Materials and Methods227 children received 255 transplants between November 2000 and September 2016. 30 patients developed PVC of whom 21 had percutaneous intervention. Retrospective clinical and procedural outcome data on these 21 patients were collected.Results21 patients, with median age 1.7 years (range 0.4–16.2), underwent 42 procedures with PTA with or without stenting. 36 procedures were for PV stenosis and 6 for PV thrombosis. Treatment was with primary PTA, with stenting reserved for suboptimal PTA result or restenosis within 3 months. 28 procedures were performed with PTA and 13 with stenting. Technical success (>50% reduction in mean pressure gradient, absolute pressure gradient ≤4 mmHg or venographic stenosis <30%) was achieved in 41 procedures. Failure to recanalise a thrombosed PV occurred in 1 procedure. There were no major procedural complications. Patients were followed-up with serial Doppler ultrasound surveillance. Kaplan–Meier estimated median primary patency was 9.9 months, with primary-assisted patency of 95% after median follow-up of 45.5 months (range 11.1–171.6).ConclusionWith regular surveillance, excellent patency rates can be achieved following percutaneous intervention for PVC post-paediatric liver transplantation.
Highlights
Percutaneous transluminal angioplasty (PTA), with or without stent placement, has become the treatment of choice for portal vein complications (PVC) following liver transplantation
Treatment was with primary PTA, with stenting reserved for suboptimal PTA result or restenosis within 3 months. 28 procedures were performed with PTA and 13 with stenting
Portal vein complications (PVC) following paediatric liver transplantation have an incidence of \3–14% [1] and can lead to graft failure resulting in significant morbidity and mortality [2,3,4]
Summary
Percutaneous transluminal angioplasty (PTA), with or without stent placement, has become the treatment of choice for portal vein complications (PVC) following liver transplantation. Results 21 patients, with median age 1.7 years (range 0.4–16.2), underwent 42 procedures with PTA with or without stenting. Conclusion With regular surveillance, excellent patency rates can be achieved following percutaneous intervention for PVC post-paediatric liver transplantation. Portal vein complications (PVC) following paediatric liver transplantation have an incidence of \3–14% [1] and can lead to graft failure resulting in significant morbidity and mortality [2,3,4]. Percutaneous transluminal angioplasty (PTA) with or without stent placement, first reported by Raby in 1991 [11], has become the primary treatment option for PVC following liver transplantation. In a small child with a postoperative abdomen, a surgical approach can be challenging
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