https://www.ncbi.nlm.nih.gov/pubmed/29470353 Liver transplantation
Transplantation. 2018 Feb 20. doi: 10.1097/TP.0000000000002138. [Epub ahead of print]
Naik KB, Hawkins CM, Gill AE, Gupta NA.

Abstract

BACKGROUND:
Stenosis of the portal vein (PV) is a rare complication after liver transplantation (LT) in pediatric patients and it adversely affects outcomes. We reviewed the safety and efficacy of percutaneous transhepatic balloon angioplasty (PTBA) as a treatment for post-LT late-onset portal vein stenosis (PVS).

METHODS:
318 patients between the ages of 0-21 years received a LT from 2001 to 2016 at this tertiary center. 21 children were evaluated for PVS using percutaneous portal venography.

RESULTS:
Of the 21, 19 patients (7F:12M) with median age 12years (7-15) were diagnosed with PVS and received PTBA. Two patients were excluded: one did not have PVS; one received shunt surgery. Median time between LT and PTBA was 83months (IQR:49-138). For patients in whom pressure could be accurately measured (n=9), mean PV pressure gradient was 6.3mmHg (SD:5.0) pre-procedure and 0.9mmHg (SD:1.2) postprocedure. Mean percentage improvement in gradient across the stenotic region was 86.2% (SD:15.9%; p<0.01). At 12-month postprocedure, there was a mean improvement (pre- vs. post-PTBA means) in bilirubin by 28.2% (0.6 vs. 0.4mg/dL, p=0.07), AST by 31.2% (116.3 vs. 28.1IU/L, p=0.04), ALT by 40.7% (140.3 vs. 28.6IU/L, p=0.07), GGT by 29.0% (337.2 vs. 38.0IU/L, p=0.06) and platelets by 62.1% (128.3 vs. 191.1x10/L, p=0.03). PV patency was successfully maintained in 18/19 patients for a median 16months (IQR:5-35). One patient received a successful repeat procedure for re-stenosis at 6 weeks.

CONCLUSION:
Angioplasty for PVS after pediatric LT is a safe and effective treatment with good patency and improved clinical outcomes. Longer follow-up studies are required.