No-Touch Hepatic Hilum Technique to Treat Early Portal Vein Thrombosis After Pediatric Liver Transplantation

作者：Bueno J^*; Perez Lafuente M; Venturi C; Segarra A; Barber I; Molino J A; Romero A; Ortega J; Bilbao I; Martinez Ibanez V; Charco R

来源：American Journal of Transplantation, 2010, 10(9): 2148-2153.

DOI：10.1111/j.1600-6143.2010.03236.x

• Angioplasty
• biliary atresia
• children
• liver transplantation
• portal vein thrombosis

A 'no-touch' hilum technique used to treat early portal vein complications post-liver transplantation in five children with body weight < 10 kg is described. Four patients developed thrombosis and one portal flow absence secondary to collateral steal flow. A vascular sheath was placed through the previous laparotomy in the ileocolic vein (n = 2), inferior mesenteric vein (n = 1) or graft umbilical vein (n = 1). Portal clots were mechanically fragmented with balloon angioplasty. In addition, coil embolization of competitive collaterals (n = 3) and stent placement (n = 1) were performed. The catheter was left in place and exteriorized through the wound (n = 2) or a different transabdominal wall puncture (n = 3). A continuous transcatheter perfusion of heparin was subsequently administered. One patient developed recurrent thrombosis 24 h later which was resolved with the same technique. Catheters were removed surgically after a mean of 10.6 days. All patients presented portal vein patency at the end of follow-up. Three patients are alive after 5 months, 1.5 and 3.5 years, respectively; one patient required retransplantation 18 days postprocedure and the remaining patient died of adenovirus infection 2 months postprocedure. In conclusion, treatment of early portal vein complications following pediatric liver transplantation with this novel technique is feasible and effective.

• 出版日期2010-9