Vascular complications after pediatric liver transplantation
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M Lallier1, D St-Vil, J Dubois
1Division of Pediatric General Surgery, Hôpital Sainte-Justine, Montreal, Quebec.
Insights
Pediatric liver transplants achieved an 83% survival rate. Vascular complications like hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) were noted, with aortic conduits posing risks.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Pediatric liver transplantation is a complex procedure with potential for significant complications.
- Understanding the incidence and risk factors for vascular complications is crucial for improving outcomes.
Purpose of the Study:
- To analyze the outcomes and vascular complication rates in pediatric liver transplant recipients.
- To identify specific risk factors associated with hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT).
Main Methods:
- Retrospective analysis of 81 pediatric liver transplantations performed between February 1986 and July 1994.
- Categorization of grafts into whole-liver grafts (WLG) and reduced-size grafts (RSG).
- Detailed review of vascular complications, including hepatic artery thrombosis (HAT), portal vein thrombosis (PVT), and aortic conduit issues.
Main Results:
- An overall patient survival rate of 83% was achieved.
- Vascular complications occurred in 21% of patients, with hepatic artery thrombosis (HAT) in 10% and portal vein thrombosis (PVT) in 6%.
- Aortic conduits were associated with a higher incidence of complications, including perforation and HAT, and were linked to patient mortality.
Conclusions:
- Pediatric liver transplantation can achieve high survival rates, but vigilance for vascular complications is essential.
- Reduced-size grafts (RSG) and whole-liver grafts (WLG) showed no significant difference in HAT incidence.
- Aortic conduits present a significant risk and should be used cautiously in pediatric liver transplantation.
Abstract:
From February 1986 to July 1994, 81 hepatic transplantations were performed in 73 children, with an overall patient survival rate of 83%. Forty-two patients received whole-liver grafts (WLG) and 39 had reduced-size grafts (RSG). The mean patient weight was 19.7 kg, with 29 patients weighing less than 10 kg. Seventeen vascular complications (21%) occurred in 13 children: 8 (10%) had hepatic artery thrombosis (HAT), 5 (6%) had portal vein thrombosis (PVT), 1 had both HAT and PVT (1%), and 3 (4%) had aortic conduit perforation (ACP). There was no significant difference in the incidence of HAT between RSG (5%) and WLG (14%) or between children weighing less than 10 kg (10%) and those weighing more than 10 kg (10%). The site of arterial reconstruction, end-to-end to the recipient common hepatic artery or end-to-side to the infrarenal aorta, had no significant effect on the occurrence of HAT (7% v 8%), but HAT occurred in 2 of 6 cases (33%) in which an aortic conduit was used. PVT documented in 5 cases (6%) was associated with technical complications (2), preduodenal portal vein (2), and a circulating cardiolipid antibody (1), and required thrombectomy, with no graft loss. Combined HAT and PVT was found in one patient 2 years postretransplantation for HAT. Although graft function is normal, portal hypertension persists. The aortic conduit, used in six patients, led to arterial perforation (3), HAT (2), and death (2). Of the 8 cases of HAT, 1 was diagnosed during autopsy and 7 occurred within 30 days and required retransplantation (6) or thrombectomy with rearterialization (1).(ABSTRACT TRUNCATED AT 250 WORDS)