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Treatments and outcomes of intra-operative portal vein thrombosis in living-donor liver transplantation due to biliary atresia

  • Kai Wang
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Chong Dong
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Chao Sun
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Weiping Zheng
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Yang Yang
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Fubo Zhang
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Chao Han
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Hong Qin
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Min Xu
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Wei Gao
    Correspondence
    Corresponding author at: Department of Pediatric transplantation, Organ transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin, China (No.24, Fukang Road, Nankai District, Tianjin, China. 300192).
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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  • Zhongyang Shen
    Affiliations
    Department of Pediatric Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China
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      ABSTRACT

      Background

      Pediatric living-donor liver transplantation (LDLT) has become one of the most effective therapies for pediatric end-stage liver diseases. We aim to investigate the risk factors for intra-operative portal vein thrombosis (PVT) and the short- and long-term outcomes in children post LDLT.

      Methods

      This was a retrospective analysis from 584 cases of biliary atresia (BA) patients who had undergone LDLT from January 2014 to December 2019 at our hospital. Patients were divided into PVT and non-PVT groups according to the occurrence of PVT during LDLT.

      Results

      The median age of recipients at transplantation was 7.22 (quartiles, 6.03, 9.50) months, the incidence of intra-operative PVT was 5.31% (31/584). The independent risk factors for intra-operative PVT were the diameter of the recipient's PV not greater than 4 mm and a higher ratio of graft-to-recipient PV diameter. The cumulative survival rates of grafts and recipients were 93.5% and 93.5% in the PVT group, and 94.9% and 95.3% in the non-PVT group, respectively, without significant difference. The recovery of graft function was similar in recipients with or without interposed graft vessel (IGV). However, the incidence of PV stenosis was higher in recipients with IGV after LDLT.

      Conclusion

      Intra-operative PVT is a common complication in pediatric LDLT, but an excellent prognosis can be achieved by appropriate and individualized surgical treatment. We noted that intra-operative PVT did not affect the survival rates of grafts and recipients, but there was a higher incidence of PV complications after LDLT.

      Level of Evidence

      KEYWORDS

      Abbreviations:

      PLT (pediatric liver transplantation), LT (liver transplantation), PV (portal vein), PVT (portal vein thrombosis), LDLT (living-donor liver transplantation), DDLT (deceased donor liver transplantation), BA (biliary atresia), IGV (interposed graft vessel), ALT (alanine aminotransferase), AST (aspartate aminotransferase), TBIL (total bilirubin), LLS (left-lateral segment), IOUS (intra-operative ultrasonography), INR (international normalized ratio), GRWR (graft to recipient weight ratio), CIT (cold ischemia time), SPLT (Studies of Pediatric Liver Transplantation), PTLD (post-transplant lymphoproliferative disorder)
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