Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Division of Radiology, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Transplant. 2021 Mar;25(2):e13835. doi: 10.1111/petr.13835. Epub 2020 Sep 4.
Sufficient PV flow is necessary to achieve successful PV reconstruction in pediatric LDLT. IOCP can be used to assess the severity of PV stenosis and to identify potential portosystemic collateral pathways. The present study reviewed the utility of IOCP and the outcomes of patients who underwent assessment with an IOCP. Consecutive primary LDLTs were performed in 488 pediatric recipients between November 2005 and October 2019. IOCP was used in patients who were unable to achieve sufficient PV flow after the ligation of collaterals. In total, 11 patients underwent IOCP to assess potential portosystemic collateral pathways. The median age and body weight was 8 months (IQR, 6-11 months) and 6.6 kg (IQR, 5.7-8.9 kg), respectively. The reasons for using the IOCP were recurrent PV thrombus in seven patients and insufficient PV flow in four patients. IOCP revealed remaining collaterals in six patients and residual hypoplastic PV in eight patients. Two patients required additional interruption of the potential collaterals under IOCP, which were unable to be recognized as a dominant portosystemic collateral pathway on preoperative imaging. All eight patients with residual hypoplastic PV required vein graft interposition for the complete removal of the hypoplastic PV. All the patients are currently doing well with a median follow-up period of 4.9 years (IQR, 2.2-5.6 years). IOCP can be an effective tool for precisely detecting occult portosystemic collateral pathways and for assessing the patency of the PV anastomosis in pediatric LDLT.
足够的门静脉流量对于成功进行小儿 LDLT 的门静脉重建是必要的。IOCP 可用于评估门静脉狭窄的严重程度，并识别潜在的门体侧支循环途径。本研究回顾了 IOCP 的应用价值以及接受 IOCP 评估的患者的结局。2005 年 11 月至 2019 年 10 月，连续对 488 例小儿受体进行了原发性 LDLT。在结扎侧支后无法获得足够的门静脉血流时，对患者使用 IOCP。共有 11 例患者接受 IOCP 以评估潜在的门体侧支循环途径。中位年龄和体重分别为 8 个月（IQR，6-11 个月）和 6.6kg（IQR，5.7-8.9kg）。使用 IOCP 的原因是 7 例患者门静脉再血栓形成和 4 例患者门静脉血流不足。IOCP 显示 6 例患者仍有侧支循环，8 例患者残留发育不良的门静脉。2 例患者需要在 IOCP 下进一步阻断潜在的侧支循环，这些侧支循环在术前影像学上无法被识别为优势门体侧支循环途径。所有 8 例残留发育不良门静脉的患者均需要静脉移植桥接以完全切除发育不良的门静脉。所有患者目前情况良好，中位随访时间为 4.9 年（IQR，2.2-5.6 年）。IOCP 可以作为一种有效工具，精确地检测隐匿性门体侧支循环途径，并评估小儿 LDLT 中门静脉吻合口的通畅性。
