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Intraoperative stent placement for the treatment of acute portal vein complications in pediatric living donor liver transplantation

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Abstract

Purpose

Pediatric living donor liver transplantation (LDLT) in low weight recipients remains one of the most complex surgical procedures, with portal vein (PV) complications occurring in up to 19% of cases. When decreased PV flow is diagnosed intra- or perioperatively, intraoperative stent placement is a good substitute for surgical adjustment. Still, at the present moment, little is known about the technical feasibility, safety, efficacy, and long-term outcome of intraoperative stenting in LDLT.

Methods

Between 2006 and 2017, seven pediatric recipients underwent PV stent placement during the transplant or in the immediate post-operative setting. Preoperative, operative, and post-operative parameters were documented retrospectively.

Results

In total, nine stents were placed in seven patients. Procedures were technically successful in all patients. During the mean imaging follow-up period of 1313 days, none of the patients showed PV abnormality and PV stent remained patent throughout the post-transplant course. There were no deaths or graft loses during the follow-up period.

Conclusions

Intraoperative stenting through the inferior mesenteric vein approach offers both a high feasibility and satisfactory results, with the potential for excellent long-term primary patency despite continued growth in children.

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Authors and Affiliations

  1. Department of General Surgery, Division of HPB Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina

    Matias E. Czerwonko, Juan Pekolj, Juan Mattera, Eduardo de Santibañes & Martín de Santibañes

  2. Department of Radiology, Division of Interventional Radiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Oscar A. Peralta & Ricardo D. García-Mónaco

Authors
  1. Matias E. Czerwonko
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  2. Juan Pekolj
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  3. Juan Mattera
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  4. Oscar A. Peralta
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  5. Ricardo D. García-Mónaco
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  6. Eduardo de Santibañes
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  7. Martín de Santibañes
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Corresponding author

Correspondence to Martín de Santibañes.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Czerwonko, M.E., Pekolj, J., Mattera, J. et al. Intraoperative stent placement for the treatment of acute portal vein complications in pediatric living donor liver transplantation. Langenbecks Arch Surg 404, 123–128 (2019). https://doi.org/10.1007/s00423-018-1741-7

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  • DOI: https://doi.org/10.1007/s00423-018-1741-7

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