Related Experiment Video
Updated: Jul 13, 2026
Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Arterial-venous fistulas following pediatric liver transplant case studies
Kathleen Falkenstein1, Louise Flynn, Stephen Dunn
1PNP Drexel University, Philadelphia, PA, and Dupont Hospital for Children, USA. kf33@drexeledu
Insights
Arterio-portal fistulas are a rare complication after pediatric liver transplants. Coil embolization offers a successful treatment option, preserving liver grafts in most cases.
Area of Science:
- Pediatric Surgery
- Hepatology
- Interventional Radiology
Background:
- Arterio-portal fistulas (AVF) are a rare but serious complication after pediatric liver transplantation, potentially leading to graft loss.
- This study describes the experience of two pediatric centers in diagnosing, treating, and evaluating outcomes of AV fistulas in children post-liver transplant.
Observation:
- The study reports five cases of late-onset arterio-portal fistulas following liver transplantation.
- Common presenting symptoms included ascites, gastrointestinal bleeding, and varices.
- Potential contributing factors identified were prior liver biopsies, percutaneous transhepatic cholangiography (PTC), non-compliance, malabsorption, and chronic diarrhea.
Findings:
- Four out of five pediatric patients with AV fistulas were successfully treated with coil embolization.
- All patients underwent liver biopsies, and some had prior PTC procedures, which may be associated with AV fistula development.
- Gastrointestinal bleeding and varices were significant clinical manifestations requiring intervention.
Implications:
- Coil embolization is an effective minimally invasive treatment for post-transplant arterio-portal fistulas in children.
- Understanding potential risk factors like prior procedures and patient compliance is crucial for prevention and management.
- Early diagnosis and intervention are key to improving outcomes and preventing graft loss in pediatric liver transplant recipients.
Abstract:
AV fistula is a rare but serious complication following pediatric liver transplant and may lead to graft loss. Our aim was to describe two pediatric centers' experience with the diagnosis, treatment and outcomes of children who presented with AV fistulas post-liver transplantation We report five cases of late arterio-portal fistula following liver transplantation. Four children were successfully treated with coil embolization. All of the children in this series had liver biopsies within 2-6 months of their AV fistula diagnosis. All biopsies were performed using a Bard Monopty 18 gauge needle with no ultrasound guidance and only one pass per biopsy. Two children also had PTC 4-8 months prior to their diagnosis of AV fistula. Three of the five children in this series had GI bleeds requiring banding or sclerotherapy. The other two had varices found on CT scan. All five cases in this series had ascites on their initial presentation. Four out of the five children had a history of non-compliance and the other child had a history of malabsorption and chronic diarrhea.
