Endovascular stent placement for venous complications following pediatric liver transplantation: outcomes and indications

• Published in: Pediatric surgery international 2019-11, Vol.35 (11), p.1185-1195
• Main Authors: Katano, Takumi, Sanada, Yukihiro, Hirata, Yuta, Yamada, Naoya, Okada, Noriki, Onishi, Yasuharu, Matsumoto, Koshi, Mizuta, Koichi, Sakuma, Yasunaru, Sata, Naohiro
• Format: Article
• Language: English
• Subjects: Adolescent; Angioplasty; Chemotherapy; Child; Child, Preschool; Disease; Endovascular Procedures; Female; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - therapy; Hepatology; Humans; Infant; Liver; Liver Transplantation - adverse effects; Liver transplants; Living Donors; Male; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Reoperation; Retrospective Studies; Stents; Surgery; Thrombosis; Tomography; Transplants & implants; Veins & arteries; Venous Thrombosis - etiology; Venous Thrombosis - therapy
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-019-04551-9

Purpose Advances in interventional radiology (IVR) treatment have notably improved the prognosis of hepatic vein (HV) and portal vein (PV) complications following pediatric living donor liver transplantation (LDLT); however, graft failure may develop in refractory cases. Although endovascular stent placement is considered for recurrent stenosis, its indications are controversial. Methods We enrolled 282 patients who underwent pediatric LDLT in our department from May 2001 to September 2016. Results 22 (7.8%) HV complications occurred after LDLT. Recurrence was observed in 45.5% of the patients after the initial treatment, and 2 patients (9.1%) underwent endovascular stent placement. The stents were inserted at 8 months and 3.8 years following LDLT, respectively. After stent placement, both patients developed thrombotic obstruction and are currently being considered for re-transplantation. 40 (14.2%) PV complications occurred after LDLT. Recurrence occurred in 27.5% of the patients after the initial treatment, and 4 patients (10.0%) underwent endovascular stent treatment. The stents of all the patients remained patent, with an average patency duration of 41 months. Conclusion Endovascular stent placement is an effective treatment for intractable PV complications following pediatric LDLT. However, endovascular stent placement for HV complications should be carefully performed because of the risk of intrastent thrombotic occlusion and the possibility of immunological venous injury.