Incidence and management of portal vein complications after pediatric liver transplantation

Farin, Coppelia [UCL] de Magnee, Catherine [UCL] de meester de Betzenbroeck, Vanessa Sokal, Etienne [UCL] Stephenne, Xavier [UCL] Scheers, Isabelle [UCL] Smets, Françoise [UCL]

Objective:To review our experience with portal vein complications (PVC) in pediatric liver transplantation (LT), managed according to various strategies along the last twenty years. Methods:Retrospective single-center analysis including 544 children with primary LT performed between 2000 and 2019. PVC were identified as early (≤30 days after LT) or late (>30 days). The following variables were studied as potential risk factors for PVC: primary diagnosis (biliary atresia vs others), transplant era (I:2000-2009 vs II:2010-2019), age at LT, type of graft (living vs deceased donor), presence of portal hypoplasia, and type of PV reconstruction (direct anastomosis, longitudinal portoplasty, jump graft). Results:Thirty-seven patients (6.8%) developed PVC, including 4 early dopplers showing reduced portal flow, 5 early thromboses, 8 late stenoses, and 20 late thromboses. Five-year patient and graft survival rates were significantly lower with vs without early PVC (37.0%vs93.7%,p<0.0001, and 16.7%vs91.0%,p<0.0001, respectively), while no differences were found in case of late PVC (91.9%vs92.9%,p=0.87, and 91.9vs90.0%,p=0.92, respectively). Five-year PVC-free survival rate with vs without PVC was found to be different (statistical significance or trend) according to: age at LT <1y (87.0%vs95.3%,p=0.002), presence of portal hypoplasia (89.2%vs94.6%,p=0.08), and direct portal anastomosis (94.4%vs88.1%,p=0.04). Conversely, PVC rate was not significantly different when considering: biliary atresia vs others (91.7%vs93.3%,p=0.44), transplant eras (92.3%vs91.7%,p=0.79), type of graft (93.9%vs91.6%,p=0.63), use of longitudinal portoplasty (89.9%vs93.2%,p=0.34), and jump graft (87.4%vs93.9%,p=0.10). Early PVC were treated using re-transplantation (n=4), meso-rex shunt (n=1) and other surgical procedures (n=5). Late PVCs were treated using re-transplantation (n=1), meso-rex shunt (n=25), meso-caval shunt (n=1), and interventional radiology (n=1). All meso-rex shunts were permeable at the most current follow-up. Conclusions: Incidence of PVC was lower than those from our previous experiences and not any more related to biliary atresia. Survival rates were compromised in early PVC. Meso-rex shunt was an effective treatment.