Long‐term outcome of primary percutaneous stent angioplasty for pediatric posttransplantation portal vein stenosis

Abstract

This study aims to evaluate the long-term efficacy and reintervention rate after primary percutaneous portal vein stent angioplasty for portal vein stenosis (PVS) in pediatric liver transplantation (LT) recipients. From 2004 to 2020, a total of 470 pediatric LTs were performed in our center. All cases were screened for interventional PVS treatment and analyzed retrospectively. We identified 44 patients with 46 percutaneous angioplasties for posttransplantation PVS. The median interval from LT to percutaneous catheter intervention was 5 months (16 days-104 months) with a median follow-up (f/u) period after catheter intervention of 5.7 years (2-156 months). In 40 patients, an endovascular stent was placed as primary (n = 38) or secondary (n = 2) intervention. The median age at stent placement was 23 (6-179) months with a median weight of 10 kg (6-46 kg).Technical success and relief of PVS were achieved in all patients irrespective of age or weight. Adverse events occurred peri-interventionally in two patients and were resolved with standard care. All primary portal vein (PV) stents remained patent until the end of f/u. Reinterventions have been successfully performed in 10 patients for suspected or proven restenosis, resulting in a primary patency rate of 75% and an assisted patency rate of 25%. The median time to reintervention was 6.2 years (range 1-10 years). The need for reintervention was independent of age or weight at both transplantation and initial angioplasty as well as of additional risk factors due to portal hypertension. Percutaneous transhepatic PV stent angioplasty in children is safe and effective in all age groups, with excellent long-term patency. Primary stent angioplasty should be considered as first-line treatment for PVS after pediatric LT.

Modified patch-conduit venoplasty for portal vein hypoplasia in pediatric liver transplantation

“…Interventional treatment for PV complications is much more difficult in pediatric than in adult LT recipients because pediatric patients have smaller PVs, and because their physical growth is ongoing [11][12][13][14][15]. Thus, the use of cryopreserved iliac veins is generally not recommended for pediatric LT.…”

Is stenting really necessary during primary angioplasty for portal vein stenosis after pediatric liver transplantation?

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To the editor,The paper by Bukova et al [1] that was published on liver transplantation dangerously questions the possibility of effectively treating portal vein stenosis after pediatric liver transplantation without the need for primary stenting. In a retrospective cohort of a total of 470 pediatric liver transplants performed in a single center from 2004 to 2020, they reported very positive outcomes with a mean follow-up of 5.7 years and they concluded that primary stent angioplasty should be considered as first-line treatment for portal vein stenosis after pediatric LT.In our opinion, this data must be considered with caution in pediatric patients who have a much longer life expectancy after liver transplantation.

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Avaliação da eficácia e segurança do acesso transesplênico na recanalização endovascular da veia porta em crianças submetidas ao transplante hepático

“…Não existe consenso na literatura em relação ao melhor protocolo de anticoagulação e/ou antigregação após a RVP em crianças (21,28,37,54) . Porém, seu uso está associado a menor recorrência da estenose/trombose venosa portal (54) .…”

“…O sucesso técnico tardio foi avaliado pelo tempo entre o procedimento e a recidiva (estenose/trombose) com necessidade de nova intervenção. Este, por sua vez, pode ser dividido em (21,43) : a) Perviedade primária -porcentagem de stents pérvios, sem necessidade de procedimento adicional, durante período de seguimento; b) Perviedade primária assistida -porcentagem de stents pérvios após intervenção para manutenção da sua perviedade devido a estenose da VP (intrastent ou nas margens proximal ou distal); c) Perviedade secundária -porcentagem de stents pérvios após intervenção para manutenção da sua perviedade devido a nova TVP.…”

“…Atualmente, a angioplastia transluminal percutânea (ATP) realizada pelo acesso trans-hepático é a primeira linha de tratamento para complicações da VP pós-transplante com ótimos resultados no tratamento da estenose portal (12,(16)(17)(18)(19)(20)(21) . No entanto, na presença de obstrução completa da VP, a recanalização do tronco da VP pelo acesso trans-hepático torna-se mais difícil, impossibilitando a sua recanalização em até 75% dos casos (20,22) .…”