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Hepatic venous outflow obstruction in pediatric liver transplantation: Technical considerations in prevention, diagnosis, and management
Author(s) -
Sommovilla J.,
Doyle M. M.,
Vachharajani N.,
Saad N.,
Nadler M.,
Turmelle Y. P.,
Weymann A.,
Chapman W. C.,
Lowell J. A.
Publication year - 2014
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12277
Subject(s) - medicine , anastomosis , liver transplantation , incidence (geometry) , surgery , ascites , percutaneous , complication , transplantation , portal vein thrombosis , vein , thrombosis , optics , physics
HVOO creates significant diagnostic and management dilemmas in pediatric liver transplant recipients, particularly with TVG s (split or reduced‐size grafts). Numerous technical variations for the hepatic vein to IVC anastomosis have been described to minimize the incidence of this complication, but no consensus for an optimal anastomotic technique exists. One hundred and thirty‐four liver transplants (70 TVG s) were performed in 124 patients between 1994 and 2011. These were divided into two cohorts. Group 1 (95 transplants, 41 TVG s) utilized a continuous running anastomosis. Group 2 (39 transplants, 29 TVG s) implemented a triangulated (three‐stitch) anastomosis. All were reviewed for demographics, diagnostics, interventions, and outcome. The overall HVOO incidence was seven of 134 transplants (5.2%) and six of 70 transplants utilizing TVG s (8.6%). Group 1 incidence was five of 41 (12.2%) compared with one of 29 (3.4%; p = 0.20, OR 3.89) in Group 2. Liver Doppler was employed in all patients, and only three suggested HVOO . All patients with HVOO underwent venogram, at a median of 81 days post‐transplant. All underwent percutaneous venoplasty and required 1–6 treatments, all resulting in HVOO resolution. Incidence of HVOO has improved since adopting the triangulated anastomosis, although not to a level of statistical significance. US is not adequately sensitive to exclude HVOO . Venogram is recommended in patients with prolonged ascites, and venoplasty has been highly successful in HVOO treatment.