Outcomes of Post-transplant Percutaneous Portal Vein Interventions: A Single Pediatric Liver Transplantation Center Experience.

IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Gaia Messana, Roberto Miraglia, Luigi Maruzzelli, Davide Coppolino, Mariapina Milazzo, Roberta Gerasia, Diletta Donà, Keid Bici, Davide Cintorino, Jean de Ville de Goyet
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引用次数: 0

Abstract

Purpose: To evaluate the long-term results of transhepatic treatment of portal vein complications (PVCs) after pediatric liver transplantation (PLTx) at a single center.

Materials and methods: All interventional procedures for PVCs after PLTx performed between 2005 and 2023 were retrospectively analyzed. Clinical signs of portal hypertension and portal vein (PV) flow velocity on Doppler ultrasound were routinely assessed during follow-up. Primary patency, assisted primary patency, and survival rates were evaluated.

Results: Out of 275 consecutive PLTs, 26 children (median age 19.8 months, range: 8.5-154.1) underwent 39 endovascular procedures for PVCs. Technical success was achieved in 97% of procedures. The median time interval between PLTx and the procedure was 5.4 months (range: 0.27-57.1). Percutaneous transluminal angioplasty (PTA) was performed in 81%, stenting in 15%, and thrombolysis in 4% of cases as the primary intervention. A significant decrease in the median trans-stenotic pressure gradient from 9 mmHg (range 4-22) to 1 mmHg (range 0-10) (p < 0.001) was observed. Recurrent stenosis was observed in 31% of patients. Two procedural complications occurred, both managed conservatively. Primary patency rates at 6 months, 1, 3, 5, and 10 years were 74%, 68%, 65%, 54%, 54%, respectively. Assisted primary patency remained 100%. The patient survival rate was 96% at all intervals. The median follow-up time was 60.47 months (range 2.2-174.3).

Conclusion: PTA should be the preferred first-line treatment for PV stenosis in PLTx recipients, with stenting reserved for refractory cases. PTA is applicable for selected cases of PV thrombosis. Regular surveillance and timely interventions ensure favorable long-term outcomes.

移植后经皮门静脉介入治疗的结果:一个儿科肝移植中心的经验。
目的:评价单中心经肝治疗小儿肝移植术后门静脉并发症的远期效果。材料和方法:回顾性分析2005年至2023年间所有PLTx术后室性心动过搏介入手术。随访期间常规评估门静脉高压症临床体征及门静脉血流速度。评估原发性通畅、辅助原发性通畅和生存率。结果:在275例连续plt中,26例儿童(中位年龄19.8个月,范围:8.5-154.1)接受了39例室性早搏血管内手术。97%的手术技术成功率。PLTx和手术之间的中位时间间隔为5.4个月(范围:0.27-57.1)。经皮腔内血管成形术(PTA)占81%,支架植入术占15%,溶栓术占4%。中位狭窄间压梯度从9 mmHg(范围4-22)显著下降到1 mmHg(范围0-10)(p结论:PTA应该是PLTx受者PV狭窄的首选一线治疗方法,对于难治性病例保留支架植入。PTA适用于选定的PV血栓病例。定期监测和及时干预可确保有利的长期结果。
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来源期刊
CiteScore
5.50
自引率
13.80%
发文量
306
审稿时长
3-8 weeks
期刊介绍: CardioVascular and Interventional Radiology (CVIR) is the official journal of the Cardiovascular and Interventional Radiological Society of Europe, and is also the official organ of a number of additional distinguished national and international interventional radiological societies. CVIR publishes double blinded peer-reviewed original research work including clinical and laboratory investigations, technical notes, case reports, works in progress, and letters to the editor, as well as review articles, pictorial essays, editorials, and special invited submissions in the field of vascular and interventional radiology. Beside the communication of the latest research results in this field, it is also the aim of CVIR to support continuous medical education. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.
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