Management and pitfall for patients with portal obstruction after pediatric living donor liver transplantation

• Published in: Japanese Journal of Portal Hypertension Vol. 16; no. 1; pp. 31 - 35
• Main Authors: Lee, Kwan-Jong, Oya, Yuuki, Inomata, Yukihiro, Okajima, Hideaki
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Portal Hypertension 2010; 日本門脈圧亢進症学会
• Subjects: pediatric living donor liver transplantation; portal vein complication; post-transplant portal vein obstruction
• ISSN: 1344-8447; 2186-6376
• DOI: 10.11423/jsph.16.31

The subject of the present study is six children with portal obstruction occurring after living donor liver transplant (LDLT). Disease that required LDLT was biliary atresia in all cases. Five out of six children were transplanted within one year after birth. Only one case showed a clinical symptom (refractory ascites) before diagnosis was made. Although radiological intervention was tried, it failed in all cases. Three cases developed gastrointestinal hemorrhage. Two of them were treated with splenorenal shunt therapy and recovered. One patient who had additional portopulmonary hypertension received re-transplantation, but she died of right cardiac heart failure during surgery. Other three cases including a child who had symptoms during the pre-diagnostic period were well without any clinical symptoms and liver function abnormalities. In conclusion, children with portal obstruction after LDLT were difficult to treat. Therefore, this complication should be detected with serial examination such as Doppler ultrasound before it occurs.