Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498 Japan.
Liver Transpl. 2010 Mar;16(3):332-9. doi: 10.1002/lt.21995.
Portal vein complications after liver transplantation (LT) are serious complications that can lead to graft liver failure. Although the treatment of interventional radiology (IVR) by means of balloon dilatation for portal vein stenosis (PVS) after LT is an effective method, the high rate of recurrent PVS is an agonizing problem. Anticoagulant therapy for PVS is an important factor for preventing short-term recurrence following IVR, but no established regimen has been reported for the prevention of recurrent PVS following IVR. In our population of 197 pediatric patients who underwent living donor liver transplantation (LDLT), 22 patients (22/197, 11.2%) suffered PVS. In the 9 earliest patients, unfractionated heparin was the only anticoagulant therapy given following IVR. In the 13 more recent patients, 3-agent anticoagulant therapy using low-molecular-weight heparin, warfarin, and aspirin was employed. In the initial group of 9 patients, 5 patients (55.6%) suffered recurrent PVS and required repeat balloon dilatation. Among the 13 more recent patients, none experienced recurrent PVS (P = 0.002). In conclusion, our 3-agent anticoagulant therapy following IVR for PVS in pediatric LDLT can be an effective therapeutic strategy for preventing recurrent PVS.
肝移植 (LT) 后门静脉并发症是严重的并发症，可导致移植物肝衰竭。尽管经介入放射学 (IVR) 行球囊扩张治疗 LT 后门静脉狭窄 (PVS) 是一种有效的方法，但 PVS 复发率高是一个令人痛苦的问题。PVS 的抗凝治疗是预防 IVR 后短期复发的重要因素，但尚未报道用于预防 IVR 后 PVS 复发的既定方案。在我们的 197 名接受活体供肝移植 (LDLT) 的儿科患者人群中，22 名患者 (22/197，11.2%) 发生 PVS。在最早的 9 名患者中，IVR 后仅使用普通肝素进行抗凝治疗。在最近的 13 名患者中，使用低分子量肝素、华法林和阿司匹林的三联抗凝治疗。在最初的 9 名患者中，有 5 名患者 (55.6%) 发生 PVS 复发，需要再次行球囊扩张。在最近的 13 名患者中，无一例发生 PVS 复发 (P = 0.002)。总之，我们对儿科 LDLT 中 PVS 行 IVR 后使用三联抗凝治疗可能是预防 PVS 复发的有效治疗策略。
