PORTAL VEIN OBSTRUCTION IN THE LONG-TERM COURSE AFTER PEDIATRIC LIVING DONOR LIVER TRANSPLANTATION.

Abstract

O157 Aims: Portal vein stenosis or occlusion is the one of the major surgical problem in pediatric living donor liver transplantation (LDLT) with the left lobe grafts, which possibly lead to graft loss. The frequency, the time after operation, the outcome of portal vein stenosis or occlusion in the long-term course after pediatric LDLT is not clear in a large series. Methods: Between June 1990 and Septmber 2003, 527 pediatric patients received primary LDLT either with the left lobe graft, left lateral segment graft or monosegment graft. Their age ranged from 27 days to 17y9m (median; 1y10m) and their body weight at the operation ranged from 3.1 Kg to 62.4 Kg (median; 10.1 Kg). Original disease were biliary cirrhosis (n=416), metabolic diseases (n=39), fulminant liver failure (n=30), liver cirrhosis (n=17), tumors (n=15), and others (n=10). Portal vein anastomosis was performed with or without vein graft according to the size of the recipient portal vein and size mismatch between recipient and graft portal vein. Blood flow of the portal vein was checked with the doppler ultrasonography every day for the first one week and every other day for the first one month. After the patient was discharged, portal blood flow was checked in the outpatient clinic when indicated. Results: Forty-one patients (7%) showed portal vein stenosis (n=29) or occlusion (n=12). Their age ranged from 4m to 17y3m (median; 1y). and their body weight at the operation ranged from 3.8Kg to 44.8Kg (median; 8.5Kg). The portal vein stenosis or occlusion was detected in the first six months in 7 patients (17%), in the next six months in 12 patients (29%), in the second year in 7 patients (17%), between 2y and 5y in 12 patients and therafter in 2 patients. In 29 patients with portal vein stenosis, percutaneous transhepatic balloon dilatation of the portal vein was successful. Two patients received portal vein re-anastomosis at 55m and 51m after LDLT. Two patients received re-LDLT at 92m and 62m due to graft failure caused by portal vein occulusion. One patient died after re-LDLT due to infection and others are all alive between 10m and 12y3m. Decrease in the portal vein flow by the doppler ultrasonography and decrease in the platelet count were the indicative signs in the patients with portal vein stenosis or occlusion. Conclusions: Portal vein stenosis or occulusion occurred in 7% of the pediatric patients in LDLT using left lobe graft. Portal vein stenosis and occulusion can be detected with the use of Doppler ultrasonogrphy and platelet count was an indicative marker. Early detection of portal vein stenosis can lead successful balloon dilatation and can avoid graft loss.