Ann Liver Transplant.  2023 May;3(1):29-34. 10.52604/alt.23.0007.

Endovascular stenting for late-onset stricture of interposed portal vein conduit following pediatric liver transplantation

• Namgoong JM
• Hwang S
• Ko GY
• Park GC
• Kim KM
• Oh SH

• KMID: 2560919
• DOI: http://doi.org/10.52604/alt.23.0007

Abstract

Portal vein (PV) interposition using a vein homograft can induce various PV complications. We present a case of pediatric living-donor liver transplantation (LDLT) showing late-onset stenosis of the interposed PV conduit, which was treated by endovascular stenting. The patient was an 11-month-old female infant weighing 7.8 kg with hepatoblastoma. She was partially responsive to systemic chemotherapy. Thus, LDLT was performed to treat the tumor. The living donor was the 34-yearold mother of the patient. After non-anatomical size reduction, the weight of the reduced left lateral section graft was 235 g, with a graft-to-recipient weight ratio of 3.0%. Recipient hepatectomy was performed according to the standard procedures of pediatric LDLT. The graft PV was anastomosed with an interposed external iliac vein homograft. The liver graft was partially accommodated in the right subphrenic fossa, resulting in dextro-plantation. The patient recovered from LDLT operation. However, at 4 months after transplantation, PV conduit stenosis occurred. This PV stenosis was initially treated with balloon dilatation, but the stenosis did not disappear. Finally, endovascular stenting was performed. The patient has been doing well for 3 years 6 months after transplantation with patent PV flow. In conclusion, interposition of PV conduit carries risk of PV conduit stenosis, hence it is necessary to perform regular follow-up studies for PV patency for a prolonged period. Radiological intervention is the only therapeutic treatment for such PV conduit stenosis.

Keyword

Portal vein hypoplasia; Portal vein stricture; Vein interposition; Pediatric liver transplantation; Endovascular stent

Figure

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  Figure 1 Pretransplant computed tomography findings of the recipient. (A) At five months before transplantation, huge multiple tumors occupied the whole liver. (B) At one month before liver transplantation, the tumor size was markedly reduced.

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  Figure 2 Pretransplant computed tomography findings of the recipient. (A) The portal vein appears hypoplastic. (B) Relative underdevelopment of the splanchnic venous system was identified.

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  Figure 3 Intraoperative photographs showing dextroplantation of the reduced left lateral section graft. (A, B) The portal vein is reconstructed with the interposed vein homograft. (C) The flat lateral part of the graft was resected and a small medial portion of segment III was removed. (D) The graft is partially accommodated in the right subphrenic fossa through dextro-rotation.

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  Figure 4 Posttransplant computed tomography findings taken at four days after transplantation. The elongated interposed portal vein is visualized (arrow) without vascular complication.

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  Figure 5 Posttransplant computed tomography findings taken at four months after transplantation. (A) The interposed portal vein conduit is completely obliterated (arrow). (B) Some collateral veins are developed (arrow).

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  Figure 6 Procedures of open balloon dilatation. (A) A small superior mesenteric vein branch was isolated and a cannula was inserted across the obliterated portal vein conduit. (B, C) Meticulous dilatation using balloons of 7 mm and 5 mm was performed. (D) The portal vein conduit was opened, but significant luminal stenosis was left.

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  Figure 7 Procedures of open endovascular stenting. (A) A cannula was inserted across the stenotic conduit. (B, C) A 10 mm×40 mm-sized endovascular wall stent was inserted. (D) The portal vein conduit was widely expanded.

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  Figure 8 Posttransplant Doppler ultrasonography taken at three years after transplantation showing good flow within the portal vein endovascular stent.

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