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Published on: September 13, 2014
Arterioportal fistulae following segmental liver transplantation in a child
L A Mieles1, D Waldman, M S Orloff
1University of Rochester Medical Center, 601 Elmwood Avenue, Box Surg, Rochester, NY 14642-8410, USA.
Insights
A rare arterio-portal fistula in a child after segmental liver transplant was successfully treated with transcatheter coil embolization. This complication, linked to graft preparation, highlights unique challenges in pediatric segmental liver transplantation.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Vascular Surgery
Background:
- Segmental liver transplantation presents unique surgical challenges distinct from whole organ transplants.
- Complications can arise from the back-table preparation and partitioning of the liver graft.
- Arterio-portal fistulae are a rare but serious potential complication in this context.
Observation:
- A 12-month-old child developed arterio-portal fistulae post-segmental liver transplantation.
- The fistula was suspected to be caused by mass ligature of a vascular pedicle during graft reduction.
- Diagnosis occurred on the third post-operative day.
Findings:
- The arterio-portal fistula was successfully managed using transcatheter coil embolization.
- The child remained well and asymptomatic 33 months after the transplantation procedure.
- This represents the first reported case of arterio-portal fistula following segmental liver transplantation.
Implications:
- Transcatheter coil embolization is an effective treatment for post-transplant arterio-portal fistulae in pediatric patients.
- Careful surgical technique during back-table graft preparation is crucial to minimize vascular complications.
- This case underscores the need for vigilance regarding specific complications associated with segmental liver transplantation.
Abstract:
We report a case of arterio-portal fistulae in a 12-month-old-child following a segmental liver transplantation. The fistula, probably the result of mass ligature of a vascular pedicle during back table allograft reduction, is to our knowledge the first such case reported. Diagnosed on the third post-operative day, the fistula was successfully managed with transcatheter coil embolization. The child is well and asymptomatic, 33 months after transplantation. In addition to those seen in whole organ transplantation, there are a few complications specifically related to segmental transplantation. These complications, although infrequent, are a direct consequence of the back table liver partition, as in the case herein reported.
