Portal vein obstruction after liver transplantation in children treated by simultaneous minilaparotomy and transhepatic approaches: Initial experience

• Published in: Pediatric transplantation 2011-02, Vol.15 (1), p.47-52
• Main Authors: Carnevale, Francisco C., Santos, Aline C. B., Seda-Neto, João, Zurstrassen, Charles E., Moreira, Airton M., Carone, Eduardo, Marcelino, Antonio S. Z., Porta, Gilda, Pugliese, Renata, Miura, Irene, Baggio, Vera D., Guimarães, Teresa, Cerri, Giovanni G., Chapchap, Paulo
• Format: Article
• Language: English
• Subjects: Administration, Oral; angioplasty; Angioplasty - methods; Anticoagulants - therapeutic use; Biological and medical sciences; Child, Preschool; children; complications; Constriction, Pathologic - complications; Diseases of the cardiovascular system; Female; General aspects; Humans; Immunosuppressive Agents - therapeutic use; Infant; Laparotomy - methods; liver transplantation; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Portal Vein - physiopathology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); stenosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; thrombosis; Thrombosis - complications; Ultrasonography, Doppler - methods
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2010.01350.x

Carnevale FC, Santos ACB, Seda‐Neto J, Zurstrassen CE, Moreira AM, Carone E, Marcelino ASZ, Porta G, Pugliese R, Miura I, Baggio VD, Guimarães T, Cerri GG, Chapchap P. Portal vein obstruction after liver transplantation in children treated by simultaneous minilaparotomy and transhepatic approaches: Initial experience.
Pediatr Transplantation 2011: 15: 47–52. © 2011 John Wiley & Sons A/S. :  Portal vein thrombosis is a complication that occurs anytime after liver transplantation and can compromise the patient and graft survival. We describe a combined technique for PV recanalization in cases of PV obstruction after liver transplantation. Four children (1%), of 367 subjected to liver transplantation from June 1991 to December 2008, underwent PV recanalization through a combined approach (transhepatic and minilaparotomy). All children received left lateral hepatic segments, developed Portal vein thrombosis (n = 3) and stenosis (n = 1), and presented with symptoms of portal hypertension after transplantation. PV recanalization was tried by transhepatic retrograde access, and a minilaparotomy was performed when percutaneous recanalization was unsuccessful. Three patients underwent a successful portal recanalization and stent placement with the combined technique. In one patient, the recanalization was unsuccessful because of an extensive portomesenteric thrombosis. The other three children had the portal flow reestablished and followed with Doppler US studies. They received oral anticoagulation for three consecutive months after the procedure and the clinical symptoms subsided. In case of PV obstruction, the combined approach is technically feasible with good clinical and hemodynamic results. It’ is a minimally invasive procedure and can be tried to avoid or delay surgical treatment or retransplantation.