Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation
10.3969/j.issn.1674-7445.2023241
- VernacularTitle:劈离式供肝儿童肝移植门静脉并发症的诊断与治疗
- Author:
Kaining ZENG
1
;
Qing YANG
1
;
Jia YAO
1
;
Hui TANG
1
;
Binsheng FU
1
;
Xiao FENG
1
;
Haijin LYU
2
;
Huimin YI
2
;
Shuhong YI
1
;
Yang YANG
1
Author Information
1. Department of Hepatic Surgery , Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-Sen University, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangdong Province Engineering Laboratory for Transplantation Medicine, Guangzhou 510630, China.
2. .
- Publication Type:OriginalArticle
- Keywords:
Pediatric liver transplantation;
Split liver transplantation;
Portal vein complication;
Portal vein stenosis;
Portal vein thrombosis;
Activated partial thromboplastin time;
Balloon dilatation;
Stenting
- From:
Organ Transplantation
2024;15(1):63-69
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.
