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Risk factors for post-operative portal vein stenosis in pediatric liver transplantation: a single center case-control
Yigang Qian1,2, Wei Zhang1,2, Weili Wang1,2
1Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Post-transplant portal vein stenosis (PVS) is a concern in pediatric liver transplants. Cryopreserved vein grafts and young liver donors increase PVS risk.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Surgery
Background:
- Post-transplant portal vein stenosis (PVS) is more common in pediatric liver transplantation (LT).
- Various portal vein (PV) reconstruction techniques may influence PVS incidence.
- Identifying risk factors is crucial for improving outcomes in pediatric LT.
Purpose of the Study:
- To investigate the incidence of PVS in pediatric LT recipients.
- To analyze the association between different PV reconstruction methods and PVS.
- To identify other potential risk factors for PVS in this population.
Main Methods:
- A cohort of 332 pediatric patients (<12 years at LT) was analyzed.
- PV reconstruction methods included: anastomosis to recipient PV trunk (Type 1), recipient PV branch patch (Type 2), vein graft interposition (Type 3), and end-to-end anastomosis (Type 4).
- Incidence of PVS was correlated with PV reconstruction types and donor age.
Main Results:
- PVS occurred in 35 (10.5%) patients.
- Among patients receiving vein grafts, 55% (11/20) with cryopreserved grafts developed PVS, versus 0% (0/12) with fresh iliac vein grafts.
- PVS developed in 18.8% (9/48) of patients who received livers from donors under 12 years old.
Conclusions:
- Cryopreserved vein graft interposition is an independent risk factor for PVS.
- Receiving a liver from a donor under 12 years old is also an independent risk factor for PVS.
- These findings highlight specific risks in pediatric LT that warrant careful consideration during surgical planning and donor selection.
Purpose:
The incidence of post-transplant poral vein stenosis (PVS) is higher in pediatric liver transplantation, probably resulting from various portal vein (PV) reconstruction methods or other factors.
Methods:
332 patients less than 12 years old when receiving liver transplantation (LT) were enrolled in this research. Portal vein reconstruction methods include anastomosis to the left side of the recipient PV trunk (type 1, n = 170), to the recipient left and right PV branch patch (type 2, n = 79), using vein graft interposition (type 3, n = 32), or end-to-end PV anastomosis (type 4, n = 50). The incidence of PVS was analyzed in terms to different PV reconstruction methods and other possible risk factors.
Results:
PVS occurred in 35 (10.5%) patients. Of the 32 patients using vein graft, 20 patients received a cryopreserved vein graft, 11 (55%) developed PVS, while the remaining 12 patients received a fresh iliac vein for PV interposition and none of them developed PVS. 9 patients whose liver donor was under 12 years old developed PVS, with an incidence of 18.8%.
Conclusion:
Cryopreserved vein graft interposition and a liver donor under 12 are independent risk factors for PVS in pediatric LT.
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