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Portal Dynamics After Living Donor Liver Transplant in Pediatric Recipients: A 10-Year Follow-Up Retrospective Study
Chi-Cheng Chen1, Hsin-You Ou1, Leo Leung-Chit Tsang1
1Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Insights
Pediatric liver transplant recipients experienced spleen size reduction initially, but it increased long-term. Portal vein diameter also grew, while flow velocity stabilized after nine months, showing complex post-transplant changes.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Transplantation Medicine
- Medical Imaging and Diagnostics
Background:
- Assessing liver transplantation (LT) impact on pediatric splenomegaly is challenging due to natural growth.
- Long-term portal vein (PV) size and flow dynamics post-LT in children remain unclear.
- Investigating long-term outcomes in pediatric liver transplant survivors is crucial.
Purpose of the Study:
- To evaluate the long-term transition of splenic size, PV size, and PV flow velocity.
- To analyze the impact of living donor liver transplantation (LDLT) on these parameters in pediatric patients surviving over 10 years.
Main Methods:
- Retrospective analysis of 39 pediatric patients undergoing LDLT (2004-2010).
- Utilized pre- and post-LDLT computed tomography (CT) scans.
- Long-term ultrasound sonography follow-up for over 10 years.
Main Results:
- Portal vein diameter showed a consistent increase over the 10-year follow-up (P < .001).
- Splenic volume regressed at 6-9 months post-LDLT (P < .001), but splenic size increased long-term.
- Portal vein flow velocity initially increased post-LDLT, then decreased, stabilizing by 6-9 months and remaining stable for 10 years.
Conclusions:
- LDLT effectively reduces splenomegaly short-term, but spleen and PV diameter may increase with growth long-term.
- PV flow velocity stabilizes 6-9 months post-LDLT and remains stable for up to 10 years.
- These findings highlight the complex, evolving nature of vascular and splenic parameters after pediatric LDLT.
Background:
It may be difficult for pediatric patients to evaluate the impact of liver transplantation (LT) on splenomegaly due to the natural growth course. The long-term dynamics of portal vein (PV) size and PV flow after LT in pediatric patients are unclear. We aimed to evaluate the long-term transition of the splenic size, PV size, and PV flow velocity in pediatric patients who underwent successful living donor liver transplantation (LDLT) and survived >10 years.
Methods:
From October 2004 to December 2010, 39 pediatric patients (25 boys; 14 girls) underwent LDLT, received pre-LDLT and post-LDLT computed tomography scans and long-term ultrasound sonography follow-up, and survived >10 years without additional intervention at our institution. We analyzed the short- to mid-term and long-term impact of LDLT on splenic size, PV size, and PV flow velocity over time.
Results:
The PV diameter increased throughout the 10-year follow-up (P < .001). The PV flow velocity increased 1 day after LDLT (P< .001); proceeded to decrease 3 days after LDLT, reaching a low point 6 to 9 months after LDLT; and remained stable throughout the 10-year follow-up. Regression of the splenic volume at 6 to 9 months after LDLT (P < .001) was noted. However, the splenic size steadily increased on long-term follow-up.
Conclusions:
Although LDLT has a significant short-term reduction effect on splenomegaly, the long-term transitional trend of the splenic size and PV diameter may increase along with children's growth. The PV flow reached a stable status 6 to 9 months after LDLT and remained so until 10 years after LDLT.
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