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Venous outflow obstruction in pediatric left lateral segment split liver transplantation
Domenico Pinelli1, Naire Sansotta2, Francesco Cavallin3
1Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
Clinical Transplantation
|April 8, 2023
Summary
Venous outflow obstruction (VOO) after pediatric liver transplantation (LT) is rare but serious, impacting graft survival. Early diagnosis and interventions like angioplasty improve outcomes, but graft loss remains a concern.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Venous outflow obstruction (VOO) is a significant cause of graft and patient loss in pediatric liver transplantation (LT).
- This study focuses on VOO in the context of left lateral segment (LLS) split LT using an end-to-side triangular venous anastomosis.
Purpose of the Study:
- To analyze the incidence, risk factors, diagnostic methods, management strategies, and outcomes of VOO in pediatric LLS split LT.
- To identify factors associated with VOO and its impact on graft survival.
Main Methods:
- Evaluation of prospective data from pediatric liver transplants performed between January 2006 and December 2021.
- Inclusion criteria: children undergoing LLS split liver transplant with end-to-side triangular anastomosis.
- VOO diagnosis based on clinical suspicion and confirmed radiologically.
Main Results:
- VOO occurred in 8.6% (24/279) of transplants.
- Associated factors included lower graft weight, re-transplantation, and presence of two hepatic veins.
- Percutaneous Transluminal Angioplasty (PTA) was effective in 77% (17/22) of cases; overall graft loss was 25%.
Conclusions:
- VOO is an uncommon but critical complication in pediatric LLS split LT, leading to significant graft loss.
- Lower graft weight, re-transplantation, and dual hepatic veins are risk factors for VOO.
- PTA is a safe and effective treatment for VOO, restoring venous outflow in most patients.
