Tuesday September 13, 2022 - 16:25 to 17:25
Vascular complications in pediatric liver transplants and their management
Emre Karakaya1, Aydıncan Akdur1, Hatice Ebru Ayvazoglu Soy1, Fatih Bouvat2, Gökhan Moray1, Mehmet Haberal1.
1General Surgery, Başkent University, Ankara, Turkey; 2Radiology, Başkent University, Ankara, Turkey
Introduction: Unlike other organs, the blood supply of the liver occurs through two systems. One of these is the hepatic artery, and it supply approximately one-third to one-fifth of the liver. The rest of the liver is supplied with blood via the portal vein. The outflow of blood circulation in the liver is via the hepatic veins. Any disruption in this blood circulation results in deterioration in liver functions. In this study, we aimed to evaluate early vascular complications in pediatric liver transplants.
Methods: From 8 November 1988 to 31 December 2021, we performed 701 LT procedures and 334 of them were pediatric.). We reviewed the medical records of these recipients for the following: primary cause of liver failure, age, and weight at the time of transplantation, type of graft, vascular complications and their management. One hundred and seventy six of the recipients were male and 158 were female. Mean age of 7.34 years (0.5 months – 17 years). Nineteen (5.7%) of the LT were deceased donor LT and 315 (94.3%) were living related liver transplant. Most cause of liver failure was biliary atresia (n=169). Mean weight of recipients was 23.3 kg . Most of graft types was left lateral graft (n=204)
Results: Hepatic vein complications occurred in 3 patients. In all three patients, stenosis was detected in the portal vein anastomosis region and was successfully treated with interventional radiological methods by placing a stent in the anastomosis region. Portal vein complications occurred in 3 patients. In one of these patients, hemostasis was performed by surgical method due to bleeding from the portal vein anastomosis. In the second patient, the anastomosis was surgically revised due to thrombus formation in the portal vein. In the third patient, due to a stenosis of more than 50% in the portal vein anastomosis, a stent was placed in the anastomosis region after balloon dilation using interventional radiological methods, and blood flow was successfully maintained. Hepatic artery complications occurred in 54 patients. Hepatic artery thrombosis occurred in 31 patients, hepatic artery stenosis in 13 patients, bleeding from hepatic artery anastomosis in 7 patients, hepatic artery dissection in 2 patients, and pseudoaneurysm in the hepatic artery in 1 patient. 43 of these patients were successfully treated with interventional radiological methods and 11 of them surgically.
Conclusion: Vascular complications seen in liver transplants can cause deterioration in hepatic functions and acute liver failure. Especially hepatic artery complications are one of the most important causes of biliary tract complications that will develop in the future. Vascular complications can be successfully treated at an early stage in experienced organ transplant centers.
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