Percutaneous treatment of portal venous stenosis in children and adolescents with segmental hepatic transplants: Long-term results

PURPOSE: To evaluate the long-term effectiveness of the percutaneous treatm ent of portal venous stenoses in children and adolescents with reduced-size hepatic transplants. MATERIALS AND METHODS: During the past 5 years, percutaneous transhepatic b alloon venoplasty was attempted in 25 children and adolescents with anastom otic portal venous stenoses that occurred after reduced-size hepatic transp lantation. All procedures were performed with direct puncture of the intrah epatic portal vein and with subsequent balloon dilation. Intravascular sten ts were deployed in patients with suboptimal results after dilation or with recurrent stenoses. RESULTS: Percutaneous venoplasty was technically successful in 19 of 25 pat ients. In the remaining six patients, portal venous occlusion precluded acc ess to the extrahepatic portal vein. Intravascular stents were deployed in 12 patients for "elastic" (n = 5) or recurrent (n = 7) stenoses. Seven pati ents who underwent successful venoplasty without stent placement have requi red no further intervention. All stents have remained patent without furthe r intervention. Portal venous patency has been maintained for 5-61 months ( mean time, 46 months) in all 19 patients. CONCLUSION: Percutaneous treatment of portal venous stenoses is effective a nd long lasting in children with reduced-size hepatic transplants. In patie nts with elastic or recurrent lesions, portal venous stents have excellent long-term primary patency despite continued patient growth. Successful, per cutaneous transhepatic venoplasty eliminates the need for surgical revision , portacaval shunting, or repeat transplantation.