Impact of Pre-Transplant Liver Hemodynamics and Portal Reconstruction Techniques on Post-Transplant Portal Vein Complications in Pediatric Liver Transplantation A Retrospective Analysis in 197 Recipients

Background and Objective: Portal vein (PV) complications are the most frequent vascular complications in pediatric liver transplant (LT). We hypothesized that pre-LT liver hemodynamic parameters and PV reconstruction technique could predict the risk of PV complications post-LT. Methods: Three hundred seventy-three children had a primary LT. A detailed ultrasound study of the pre-LT native liver hemodynamics was available in 198 cases, with details of PV anastomosis available for 197 of these: end-to-end anastomosis (n = 146, 74%), interposition vein graft technique (n = 28, 14%), or portoplasty (latero-lateral anastomosis of vein graft and recipient PV) (n = 23, 12%). Results: Overall 5-year patient survival rate was 90%. Among the 198 patients with pre-LT hemodynamic data, 79 (40%) had PV hypoplasia (diameter <= 4 mm), 64 (32%) had a pathological portal flow (nonhepatopetal flow), and 47 (24%) had an arterial resistance index (ARI) >= 1. Abnormal hemodynamics were mostly observed in biliary atresia (BA). Among these 3 parameters, only ARI >= 1 was significantly correlated with a higher rate of PV complications post-LT (P = 0.041). PV complication-free survival at 5 years were 91% for end-to-end anastomosis, 91% for portoplasty, and 62% for interposition vein graft technique (P = 0.002). At multivariate analysis, the use of an interposition vein graft was the only factor to be significantly associated with a higher rate of PV complications post-LT (P = 0.003). Conclusions: PV hypoplasia with liver hemodynamic disturbances was mainly observed in BA. Hepatic ARI >= 1 might be a good predictor of PV complications post-LT. Latero-lateral portoplasty seemed to provide the best results when end-to-end anastomosis is not feasible.