Portal vein thrombosis in biliary atresia patients after living donor liver transplantation

• Published in: Surgery 2011, Vol.149 (1), p.40-47
• Main Authors: Ou, Hsin-You, MD, Concejero, Allan M., MD, Huang, Tung-Liang, MD, Chen, Tai-Yi, MD, Tsang, Leo Leung-Chit, MD, Chen, Chao-Long, MD, Yu, Pao-Chu, MD, Yu, Chun-Yen, MD, Cheng, Yu-Fan, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Analysis of Variance; Biliary Atresia - diagnostic imaging; Biliary Atresia - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Child; Child, Preschool; Cohort Studies; Confidence Intervals; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; General aspects; Graft Rejection; Humans; Infant; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Male; Medical sciences; Multivariate Analysis; Portal Vein; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Predictive Value of Tests; Preoperative Care - methods; Retrospective Studies; Risk Assessment; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Treatment Outcome; Ultrasonography, Doppler; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - etiology; Venous Thrombosis - therapy; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2010.04.018

Background Vascular complications are major complications after living donor liver transplantation (LDLT), especially in biliary atresia (BA). Early diagnosis and treatment of portal vein thrombosis (PVT) may ensure optimal graft function and good recipient survival. Our aim was to find any association between pre- and post-transplant anatomic characteristics and hemodynamics, and the occurrence of post-transplant PVT in BA patients undergoing LDLT. Methods We evaluated the pre- and post-transplant findings in ultrasonography in 105 BA recipients who underwent primary LDLT to determine the possible associated factor(s) and ultrasonographic warning sign(s) that may cause PVT development after LDLT. Results There were 53 male and 52 female recipients. The mean age, height, and weight were 2.8 years, 83.6 cm, and 12.5 kg, respectively. Occlusion of the portal vein (PV) developed in 8 patients. On multivariate analysis, the only independent, pretransplant risk factor predisposing to PV occlusion post-transplant was small main PV size ( P = .008). Post-transplant ultrasonographic warning signs included PV flow 70 cm/sec ( P = .027), and lesser hepatic artery resistance index