Strategy to prevent recurrent portal vein stenosis following interventional radiology in pediatric liver transplantation

Abstract

Portal vein complications after liver transplantation (LT) are serious complications that can lead to graft liver failure. Although the treatment of interventional radiology (IVR) by means of balloon dilatation for portal vein stenosis (PVS) after LT is an effective method, the high rate of recurrent PVS is an agonizing problem. Anticoagulant therapy for PVS is an important factor for preventing short-term recurrence following IVR, but no established regimen has been reported for the prevention of recurrent PVS following IVR. In our population of 197 pediatric patients who underwent living donor liver transplantation (LDLT), 22 patients (22/197, 11.2%) suffered PVS. In the 9 earliest patients, unfractionated heparin was the only anticoagulant therapy given following IVR. In the 13 more recent patients, 3-agent anticoagulant therapy using low-molecular-weight heparin, warfarin, and aspirin was employed. In the initial group of 9 patients, 5 patients (55.6%) suffered recurrent PVS and required repeat balloon dilatation. Among the 13 more recent patients, none experienced recurrent PVS (P ¼ 0.002). In conclusion, our 3-agent anticoagulant therapy following IVR for PVS in pediatric LDLT can be an effective therapeutic strategy for preventing recurrent PVS. Liver Transpl 16:332-339,

Vascular complications following liver transplantation: A literature review of advances in 2015

“…Shibata et al [128] (2005) reported the most important series in the literature where the recurrence rate was 28.6%. Some authors recommend the use of anticoagulant therapy for the prevention of recurrent PVT [134] . Recently, Sanada et al [134] (2010) concluded that the use of three anticoagulant therapies, i.e., lowmolecularweight heparin, warfarin and aspirin, significantly reduced the recurrence of thrombosis with a median followup of three months [134] .…”

“…Some authors recommend the use of anticoagulant therapy for the prevention of recurrent PVT [134] . Recently, Sanada et al [134] (2010) concluded that the use of three anticoagulant therapies, i.e., lowmolecularweight heparin, warfarin and aspirin, significantly reduced the recurrence of thrombosis with a median followup of three months [134] . Additionally, some authors have coupled endovascular treatment with surgical PV access [106] .…”

Percutaneous segmental dilatation of portal stenosis after paediatric liver transplantation to avoid or postpone surgery: two cases and literature review

“…3,4,5). Imaging performed immediately after angioplasty documented the partial success of the procedure with persistence of reverse flow in the splenic vein.…”

“…Patency of the vascular reconstructions is a key factor in the success of LT [3], and complications of the portal anastomotic stenosis may cause the failure of surgery [4]. The disproportion in vessel calibre between adult donor and recipient, tension and torsion of the anastomosis (sometimes treated with surgical patches) are the main causes of early or late portal stenosis [3].…”

“…Surgical revision of the portal anastomosis is very often complex and risky [3]. Percutaneous transhepatic angioplasty is considered a safe and effective technique, although few reports have been published on this topic, especially as far as paediatric patients are concerned [2][3][4][5][6][7].…”