PORTAL-VEIN THROMBOSIS AND STENOSIS IN PEDIATRIC LIVER-TRANSPLANTATION

The aim of this study was to determine the outcome of venous conduits used in living donor Liver transplantation (LDLT), We analyzed the por tal vein complications in 66 LDLT recipients and 48 cadaveric reduced- size liver transplant (RLT) recipients performed from November 1989 th rough January 1995, Three different venous conduits were utilized in t he LDLT recipients: Group 1, reconstructed vein from the living donor, n = 18; Group 2, cadaveric cryopreserved iliac vein, n = 37; and Grou p 3, cadaveric cryopreserved femoral vein, n = 11, Overall, 47 percent of the patients were less than one year of age; the age distribution was not significantly different among the groups, The incidence of ear ly thrombosis was significantly greater in LDLT Group 1, (33%) than an y of the other groups (LDLT Group 2, 8%; LDLT Group 3, 9%; and RLT,4%; P < 0.005 vs, reduced graft and < 0.03 vs. other LDLT groups), The in cidence of late portal vein stenosis or thrombosis was significantly h igher in the LDLT Group 2, (51%) than any of the other groups (LDLT Gr oup 1, 16%; LDLT Group 3, 9%; RLT 4%; P < 0.005 vs, cadaveric and < 0. 02 vs, LDLT Group 1 and LDLT Group 3), sive year actuarial graft and p atient survival for patients who have experienced portal vein thrombos is or stenosis is 61% and 67%, respectively, versus 67% and 71% for th ose patients who have not experienced portal vein pathology, P = ns. B ased on this experience, we recommend avoiding the use of cryopreserve d iliac vein for portal vein reconstruction in liver transplantation E very effort should be taken to eliminate the need for venous conduits in Liver transplantation. If venous conduits must be utilized, cryopre served femoral veins seem to provide superior patency rates, Careful c linical and ultrasonographic monitoring of patients at high risk for l ate venous thrombosis permits therapy with excellent graft and patient survival.