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Updated: Apr 28, 2026
Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Cavo-portal transposition in pediatric liver transplant recipients
Marek Szymczak1, Piotr Kaliciński2, Wojciech Kwiatkowski2
1Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland.
Insights
Cavo-portal transposition (CPT) is a viable surgical option for liver transplant recipients with portal vein thrombosis. This technique offers effective portal revascularization, showing no long-term complications in pediatric cases.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Surgery
- Pediatric Surgery
Background:
- Liver transplantation (LTx) in pediatric patients often faces challenges with portal vein patency.
- Portal system thrombosis necessitates alternative strategies for portal revascularization, such as cavo-portal transposition (CPT).
- CPT provides a crucial alternative when standard porto-portal anastomosis is not feasible.
Observation:
- Two pediatric cases involving liver transplantation with CPT are presented.
- Case 1: A 10-year-old boy with prior Kasai procedure and LTx experienced late portal vein thrombosis and underwent re-transplantation with CPT.
- Case 2: A 14-month-old child with a Kasai procedure had undiagnosed portal system thrombosis during LTx, necessitating CPT.
Findings:
- Both pediatric patients demonstrated successful portal revascularization via CPT.
- Follow-up revealed normal graft function, absence of gastrointestinal bleeding, and no significant complications like ascites or renal dysfunction.
- Doppler ultrasound confirmed normal portal and arterial flow in the transplanted livers.
Implications:
- CPT is an essential technique for achieving portal revascularization in liver transplant recipients with complex vascular issues.
- Long-term outcomes in these pediatric cases suggest CPT is safe and effective, avoiding late complications.
- This approach expands the possibilities for successful liver transplantation in challenging recipient scenarios.
Background:
Cavo-portal transposition (CPT) at liver transplantation (LTx) allows portal revascularization of the liver in recipients in whom portal system thrombosis does not allow performance of porto-portal anastomosis. The aim was to present the cases of 2 children who underwent LTx and CPT in our institution.
Case Report:
1. A 10-year-old boy, after Kasai procedure and living donor LTx, was qualified for retransplantation 9 years after first LTx complicated with late portal vein thrombosis, portal hypertension, hypersplenism, and multiple GI bleeding episodes, after splenectomy and meso-caval shunt preventing GI bleeding. At retransplant surgery, CPT was done. Actual follow-up was 40 months. Doppler ultrasound and angio CT show normal flow within the graft's portal vein. Biochemical parameters were within normal range. There was no bleeding from the gastrointestinal tract. 2. A 14-month-old child after Kasai procedure was qualified for living donor liver transplantation. During surgery, thrombosis of the recipient portal system was found, which was not diagnosed before. The CPT was done. There were no complications during the postoperative course. The actual follow-up was 32 months, and the patient is doing well, with normal liver and renal function, without hypersplenism or ascites. There was no gastrointestinal bleeding. Doppler ultrasound showed normal intrahepatic portal and arterial flow in the transplanted liver.
Conclusions:
Cavo-portal transposition is an important option in portal vein revascularization in liver transplant recipients without access to the portal system. Long-term observation of these 2 cases did not show any late problems (e.g., bleeding from the gastrointestinal tract, renal function, hyperammonemia, ascites) related to cavo-portal transposition.
