Department of Pediatric Cardiology and Pediatric Intensive Care Hannover Medical School Hannover Germany Department of Pediatric Pneumology, Allergy and Neonatology Hannover Medical School Hannover Germany Clinic of Pediatric Kidney, Liver and Metabolic Diseases Hannover Medical School Hannover Germany Department of General, Visceral and Transplantation Surgery Hannover Medical School Hannover Germany.
Liver Transpl. 2022 Sep;28(9):1463-1474. doi: 10.1002/lt.26488. Epub 2022 May 20.
This study aims to evaluate the long-term efficacy and reintervention rate after primary percutaneous portal vein stent angioplasty for portal vein stenosis (PVS) in pediatric liver transplantation (LT) recipients. From 2004 to 2020, a total of 470 pediatric LTs were performed in our center. All cases were screened for interventional PVS treatment and analyzed retrospectively. We identified 44 patients with 46 percutaneous angioplasties for posttransplantation PVS. The median interval from LT to percutaneous catheter intervention was 5 months (16 days-104 months) with a median follow-up (f/u) period after catheter intervention of 5.7 years (2-156 months). In 40 patients, an endovascular stent was placed as primary (n = 38) or secondary (n = 2) intervention. The median age at stent placement was 23 (6-179) months with a median weight of 10 kg (6-46 kg). Technical success and relief of PVS were achieved in all patients irrespective of age or weight. Adverse events occurred peri-interventionally in two patients and were resolved with standard care. All primary portal vein (PV) stents remained patent until the end of f/u. Reinterventions have been successfully performed in 10 patients for suspected or proven restenosis, resulting in a primary patency rate of 75% and an assisted patency rate of 25%. The median time to reintervention was 6.2 years (range 1-10 years). The need for reintervention was independent of age or weight at both transplantation and initial angioplasty as well as of additional risk factors due to portal hypertension. Percutaneous transhepatic PV stent angioplasty in children is safe and effective in all age groups, with excellent long-term patency. Primary stent angioplasty should be considered as first-line treatment for PVS after pediatric LT.
本研究旨在评估儿童肝移植（LT）受者原发性经皮门静脉支架血管成形术治疗门静脉狭窄（PVS）的长期疗效和再干预率。2004 年至 2020 年，我们中心共进行了 470 例儿童 LT。所有病例均行介入性 PVS 治疗筛查，并进行回顾性分析。我们共确定了 44 例 46 例移植后 PVS 经皮血管成形术患者。LT 至经皮导管介入的中位时间间隔为 5 个月（16 天至 104 个月），导管介入后中位随访（f/u）时间为 5.7 年（2 至 156 个月）。在 40 例患者中，作为原发性（n=38）或继发性（n=2）介入，放置了血管内支架。支架放置时的中位年龄为 23（6-179）个月，中位体重为 10kg（6-46kg）。所有患者均实现了技术成功和 PVS 缓解，无论年龄或体重。有 2 例患者在介入期间发生不良事件，经标准治疗后得以解决。所有原发性门静脉（PV）支架在 f/u 结束时均保持通畅。10 例患者因可疑或证实再狭窄而成功进行了再介入治疗，导致原发性通畅率为 75%，辅助通畅率为 25%。再介入的中位时间为 6.2 年（范围 1-10 年）。再介入的需要与移植时和初次血管成形术时的年龄或体重以及由于门静脉高压引起的其他危险因素无关。经皮经肝 PV 支架血管成形术在所有年龄段的儿童中均安全有效，具有良好的长期通畅率。原发性支架血管成形术应被视为儿童 LT 后 PVS 的一线治疗方法。
