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Early vascular complications after pediatric liver transplantation
E Sieders1, P M Peeters, E M TenVergert
1Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, University Hospital Groningen, The Netherlands. E.Sieders@chir.azg.nl
Insights
Vascular complications like hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) impact pediatric liver transplant outcomes. Identifying and avoiding risk factors such as size disparity can improve patient and graft survival.
Area of Science:
- Transplantation Surgery
- Vascular Surgery
- Pediatric Surgery
Background:
- Vascular complications significantly affect liver transplant outcomes.
- Hepatic artery thrombosis (HAT) is commonly studied, but other vascular issues are also critical.
- Pediatric liver transplantation involves unique challenges regarding vascular complications.
Purpose of the Study:
- To analyze the incidence, consequences, and risk factors of HAT, PVT, and venous outflow tract obstruction (VOTO) in pediatric liver transplants.
- To determine the impact of these vascular complications on patient and graft survival.
- To identify modifiable risk factors to improve transplant outcomes.
Main Methods:
- Retrospective analysis of 157 consecutive pediatric liver transplantations.
- Evaluation of incidences for HAT, PVT, and VOTO.
- Analysis of recipient, donor, and surgical factors associated with vascular complications.
Main Results:
- Overall vascular complication rate was 21% (HAT 10%, PVT 4%, VOTO 6%).
- PVT and VOTO negatively impacted patient survival; HAT and PVT affected graft survival.
- Risk factors included low donor-recipient age ratio, long surgery, segmental grafts, and size disparity.
Conclusions:
- Vascular complications are frequent and detrimental in pediatric liver transplantation.
- Donor-recipient size disparity is a key risk factor, particularly with segmental grafts.
- Avoiding identified risk factors may enhance patient and graft survival post-transplant.
Abstract:
Vascular complications have a detrimental effect on the outcome after liver transplantation. Most studies focus exclusively on hepatic artery thrombosis (HAT). The current study analyzed the incidence, consequences, and risk factors for HAT, portal vein thrombosis (PVT), and venous outflow tract obstruction (VOTO) in a consecutive series of 157 pediatric liver transplantations. The overall incidence of vascular complications was 21%. The incidences of HAT, PVT, and VOTO were 10%, 4%, and 6%, respectively. Patient survival after PVT and VOTO and graft survival after HAT and PVT were less compared with survival of grafts without vascular complications. To identify risk factors for vascular complications, factors related to recipient, donor, and surgical techniques were analyzed. A low donor-recipient (D/R) age ratio, long surgical time, and use of the proper hepatic artery of the recipient for arterial reconstruction were risk factors for HAT. Young age, low weight, segmental grafts, and piggyback technique were risk factors for PVT. Fulminant hepatic failure, high D/R age and weight ratios, and use of segmental grafts were related to VOTO. Vascular complications, which occurred in 21% of the pediatric liver transplantations, had a significant impact on patient and graft survival. Size disparity between donor and recipient was an important risk factor for vascular complications, especially in the case of transplantation of segmental grafts. Patient and graft survival might improve by avoiding the identified risk factors.