Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Transplant Services, Children's Healthcare of Atlanta (CHOA), Atlanta, GA.
Transplantation. 2018 Jun;102(6):e282-e287. doi: 10.1097/TP.0000000000002138.
Stenosis of the portal vein (PV) is a rare complication after liver transplantation (LT) in pediatric patients, and it adversely affects outcomes. We reviewed the safety and efficacy of percutaneous transhepatic balloon angioplasty (PTBA) as a treatment for post-LT late-onset PV stenosis (PVS).
Three hundred eighteen patients between the ages of 0 and 21 years received an LT from 2001 to 2016 at this tertiary center. Twenty-one children were evaluated for PVS using percutaneous portal venography.
Of the 21, 19 patients (7 female, 12 male) with a median age of 12 years (7-15 years) were diagnosed with PVS and received PTBA. Two patients were excluded: one did not have PVS, and one received shunt surgery. Median time between LT and PTBA was 83 months (interquartile range, 49-138). For patients in whom pressure could be accurately measured (n = 9), mean PV pressure gradient was 6.3 mm Hg (SD, 5.0) preprocedure and 0.9 mm Hg (SD, 1.2) postprocedure. Mean percentage improvement in gradient across the stenotic region was 86.2% (SD, 15.9%; P < 0.01). At 12-month postprocedure, there was a mean improvement (pre-PTBA vs post-PTBA means) in bilirubin by 28.2% (0.6 mg/dL vs 0.4 mg/dL, P = 0.07), aspartate aminotransferase by 31.2% (116.3 IU/L vs 28.1 IU/L, P = 0.04), alanine aminotransferase by 40.7% (140.3 IU/L vs 28.6 IU/L, P = 0.07), γ-glutamyltransferase by 29.0% (337.2 IU/L vs 38.0 IU/L, P = 0.06) and platelets by 62.1% (128.3 vs 191.1 × 10/L, P = 0.03). The PV patency was successfully maintained in 18 of 19 patients for a median of 16 months (interquartile range, 5-35). One patient received a successful repeat procedure for restenosis at 6 weeks.
Angioplasty for PVS after pediatric LT is a safe and effective treatment with good patency and improved clinical outcomes. Longer follow-up studies are required.
儿童肝移植（LT）后门静脉狭窄（PV）是一种罕见的并发症，会对预后产生不利影响。我们回顾了经皮经肝球囊血管成形术（PTBA）作为治疗 LT 后迟发性 PV 狭窄（PVS）的安全性和有效性。
本研究纳入了 2001 年至 2016 年在本三级中心接受 LT 的 318 名 0 至 21 岁的患者。21 名儿童通过经皮门静脉造影术评估是否存在 PVS。
21 名儿童中，19 名（7 名女性，12 名男性）诊断为 PVS，并接受了 PTBA，中位年龄为 12 岁（7-15 岁）。2 名儿童被排除在外：1 名儿童没有 PVS，1 名儿童接受了分流手术。LT 与 PTBA 之间的中位时间为 83 个月（四分位距，49-138）。在可以准确测量压力的 9 名患者中，PV 压力梯度术前为 6.3mmHg（标准差，5.0），术后为 0.9mmHg（标准差，1.2）。狭窄部位的梯度平均改善率为 86.2%（标准差，15.9%；P＜0.01）。术后 12 个月，胆红素平均改善（术前 vs 术后均值）为 28.2%（0.6mg/dL 比 0.4mg/dL，P=0.07），天冬氨酸转氨酶为 31.2%（116.3IU/L 比 28.1IU/L，P=0.04），丙氨酸转氨酶为 40.7%（140.3IU/L 比 28.6IU/L，P=0.07），γ-谷氨酰转移酶为 29.0%（337.2IU/L 比 38.0IU/L，P=0.06），血小板为 62.1%（128.3 比 191.1×10/L，P=0.03）。19 名患者中有 18 名的 PV 通畅性在中位 16 个月（四分位距，5-35）内得到成功维持。1 名患者在 6 周时因再狭窄接受了成功的重复介入治疗。
儿童 LT 后 PVS 的血管成形术是一种安全有效的治疗方法，具有良好的通畅率和改善的临床结果。需要进行更长时间的随访研究。
