Skip to main content
SpringerLink
Log in

Portal Vein Complications after Pediatric Liver Transplantation

  • Pediatric Gastroenterology (SR Orenstein, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Relatively few pediatric donors are available in relation to the number of children waiting for a liver transplant. This limited number of pediatric donor livers leads to the use of adult livers, usually requiring more complex portal vein (PV) anastomoses. These anastomoses are complicated by differences in PV caliber between donors and recipients, as well as by limitations of PV length, which may be inadequate to reach the recipient spleno-mesenteric junction. Three types of post-transplant complications result from these complexities: 1) anomalies of the portal flow; 2) stenosis of the PV anastomosis; and 3) PV thrombosis. Abnormal portal flow may rarely need a specific intervention, but persistent stenosis or appearance of signs of portal hypertension need to be corrected. Balloon dilatation and placement of a stent are usually successful to repair stenosis. Portal vein thromboses are in general diagnosed in the immediate post-operative period and frequently lead to re-transplantation; however, thrombolytic therapy should be attempted in children without major signs of liver necrosis. When intra-hepatic portal vein(s) are permeable, despite extrahepatic PV thrombosis, a Meso-Rex shunt may be the indicated therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Lambotte L, Li B, Leclercq I, et al. The compensatory hyperplasia (liver regeneration) following ligation of a portal branch is initiated before the atrophy of the deprived lobes. J Hepatol. 2000;32:940–5.

    Article  PubMed  CAS  Google Scholar 

  2. Cantor HM, Dumont AE. Hepatic suppression of sensitization to antigen absorbed into the portal system. Nature. 1967;215:744–5.

    Article  PubMed  CAS  Google Scholar 

  3. May AG, Bauer S, Leddy JP, et al. Survival of allografts after hepatic portal venous administration of specific transplantation antigen. Ann Surg. 1969;170:824–32.

    Article  PubMed  CAS  Google Scholar 

  4. Gorczynski RM. Immunosuppression induced by hepatic portal venous immunization spares reactivity in IL-4 producing T lymphocytes. Immunol Lett. 1992;33:67–77.

    Article  PubMed  CAS  Google Scholar 

  5. Jiang SM, Zhou GW, Zhang R, et al. Role of splanchnic hemodynamics in liver regeneration after living donor liver transplantation. Liver Transpl. 2009;15:1043–9.

    Article  PubMed  Google Scholar 

  6. Marwan IK, Fawzy AT, Egawa H, et al. Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation. Surgery. 1999;125:265–70.

    Article  PubMed  CAS  Google Scholar 

  7. • de Magnée C, Bourdeaux C, de Dobbeleer F, et al. Impact of pre-transplant liver hemodynamics and portal reconstruction techniques on post-transplant portal vein complications in pediatric liver transplantation: a retrospective analysis in 197 recipients. Ann Surg. 2011;254:55–61. This article showed the influence of pre-liver transplantation hemodynamic parameters and portal vein reconstruction technique on the outcome portal blood flow. Biliary atresia was found to be the main responsible of portal vein hypoplasia. The authors described an arterial resistence index (ARI) significantly correlated with a higher rate of portal vein complications. ARI was calculated according to the following formula: ARI = (Maximal systolic velocity – Maximal diastolic velocity)/Maximal systolic velocity.

    Article  PubMed  Google Scholar 

  8. • Shibasaki S, Taniguchi M, Shimamura T, et al. Risk factors for portal vein complications in pediatric living donor liver transplantation. Clin Transplant. 2010;24:550–6. The authors described portal vein complications in a cohort of liver transplanted children. They found that the size of the portal vein, younger age, low portal venous flow, and high hepatic arterial flow influenced the incidence of portal vein complications.

    Article  PubMed  Google Scholar 

  9. • Shigeta T, Kasahara M, Sakamoto S, et al. Balloon-occluded retrograde transvenous obliteration for a portosystemic shunt after pediatric living-donor liver transplantation. J Pediatr Surg. 2011;46:19–22. This publication proposed a balloon—occluded retrograde obliteration of enlarged portal vein collaterals to reduce the steal phenomenon, and to improve post-transplantation portal vein flow.

    Article  Google Scholar 

  10. • Slater RR, Jabbour N, Abbass AA, et al. Left renal vein ligation: a technique to mitigate low portal flow from splenic vein siphon during liver transplantation. Am J Transplant. 2011;11:1743–7. This article underlined the importance of searching for shunts siphoning portal flow. Persistence of them in the post-transplantation period can compromise portal flow to the liver, and consequently the allograft survival.

    Article  PubMed  CAS  Google Scholar 

  11. Tallon AL, Jimenez RG, Suarez AG, et al. Posttransplantation portal thrombosis secondary to splenorenal shunt persistence. Transplant Proc. 2010;42:3169–70.

    Article  Google Scholar 

  12. Horrow MM, Phares MA, Viswanadhan N, et al. Vascular steal of the portal vein after orthotopic liver transplant: intraoperative sonographic diagnosis. J Ultrasound Med. 2010;29:125–8.

    PubMed  Google Scholar 

  13. Kim JH, Ko GY, Sung KB, et al. Transvenous variceal embolization during or after living-donor liver transplantation to improve portal venous flow. J Vasc Interv Radiol. 2009;20:1454–9.

    Article  PubMed  Google Scholar 

  14. Castillo-Suescun F, Oniscu GC, Hidalgo E. Hemodynamic consequences of spontaneous splenorenal shunts in deceased donor liver transplantation. Liver Transpl. 2011;17:891–5.

    Article  PubMed  Google Scholar 

  15. Lafosse A, de Magnee C, Brunati A, et al. Combination of tissue expansion and porcine mesh for secondary abdominal wall closure after pediatric liver transplantation. Pediatr Transplant 2011, [Epub ahead of print].

  16. Moon SB, Moon JI, Kwon CH, et al. Graft rotation and late portal vein complications in pediatric living donor liver transplantation using left-sided grafts: long-term computed tomography observations. Liver Transpl. 2011;17:717–22.

    Article  PubMed  Google Scholar 

  17. Francesco F, Gruttadauria S, Caruso S, et al. Huge extrahepatic portal vein aneurysm as a late complication of liver transplantation. World J Hepatol. 2010;2:201–2.

    PubMed  Google Scholar 

  18. Buell JF, Funaki B, Cronin DC, et al. Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg. 2002;236:658–66.

    Article  PubMed  Google Scholar 

  19. Diamond IR, Fecteau A, Millis JM, et al. Impact of graft type on outcome in pediatric liver transplantation: a report From Studies of Pediatric Liver Transplantation (SPLIT). Ann Surg. 2007;246:301–10.

    Article  PubMed  Google Scholar 

  20. Funaki B, Rosenblum JD, Leef JA, et al. Percutaneous treatment of portal venous stenosis in children and adolescents with segmental hepatic transplants: long-term results. Radiology. 2000;215:147–51.

    PubMed  CAS  Google Scholar 

  21. Sanada Y, Kawano Y, Mizuta K, et al. Strategy to prevent recurrent portal vein stenosis following interventional radiology in pediatric liver transplantation. Liver Transpl. 2010;16:332–9.

    PubMed  Google Scholar 

  22. Braun MM, Bar-Nathan N, Shaharabani E, et al. Postshunt hepatic encephalopathy in liver transplant recipients. Transplantation. 2009;87:734–9.

    Article  PubMed  Google Scholar 

  23. • Superina R, Shneider B, Emre S, et al. Surgical guidelines for the management of extra-hepatic portal vein obstruction. Pediatr Transplant. 2006;10:908–13. This manuscript summarized expert opinions on the feasibility, indication, and results of the meso-Rex bypass in patients with extra-hepatic vein obstruction. The technique was described some years ago by one of the co-authors of this article. Meso-Rex shunt restores physiologic blood flow to the liver.

    Article  PubMed  Google Scholar 

  24. • Eyraud D, Granger B, Ionescu C, et al. Thrombocytopenia, splenomegaly, and portal blood flow in patients with liver transplants. Liver Transpl 2011, [Epub ahead of print]. This interesting reference described the evolution of splenomegaly and platelet count in the post-transplantation follow-up in adult patients. In our experience, similar results are observed in children.

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, CHU-Sainte Justine, Department of Pediatrics, University of Montreal, 3175, Côte Sainte Catherine, Montreal, H3T 1C5, Québec, Canada

    Fernando Alvarez

Authors
  1. Fernando Alvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando Alvarez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alvarez, F. Portal Vein Complications after Pediatric Liver Transplantation. Curr Gastroenterol Rep 14, 270–274 (2012). https://doi.org/10.1007/s11894-012-0257-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-012-0257-5

Keywords

Search

Navigation