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

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

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).

Conclusions: 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.