PORTAL-VEIN STENOSIS IN CHILDREN WITH SEGMENTAL LIVER-TRANSPLANTS - TREATMENT WITH PERCUTANEOUS TRANSHEPATIC VENOPLASTY

OBJECTIVE. We reviewed the early results of percutaneous portal venopl asty as a method of treating portal vein stenosis in II children with reduced-size liver transplants. SUBJECTS AND METHODS. Percutaneous tra nshepatic portal venoplasty was attempted in 11 children with portal v ein stenoses over a period of 9 months. The venoplasty was performed b y direct puncture of an intrahepatic portal vein followed by balloon a ngioplasty of the stenotic segment. Patients presented with symptoms o f portal venous hypertension or were identified by routine surveillanc e with posttransplant Doppler sonography. All stenoses were verified w ith angiography before portal venoplasty was attempted. In patients wi th suboptimal results after portal venoplasty or who developed recurre nt stenoses, intravascular stents were placed across stenoses. RESULTS . In eight of 11 patients, initial clinical and technical success was achieved. Intravascular stents were placed in two of these patients. I n the three unsuccessful procedures, complete occlusion of the portal vein precluded Vascular access. Two procedure-related complications an d one nonprocedure-related complication developed. In one patient, the portal vein restenosed after 6 months, and a metallic intravascular s tent was placed to alleviate the stenosis. Portal vein patency in all other successful procedures has been maintained for 3-9 months (mean, 6.1 months) without further intervention. CONCLUSION. Percutaneous tra nshepatic portal venoplasty of portal vein stenosis in children with l iving, related liver transplant donors has excellent early results. In patients with this complication, the procedure has become the initial choice in our hospital, eliminating the need for surgical revision, p ortacaval shunting, or retransplantation.