Frequency of and factors associated with vascular complications after pediatric liver transplantation

Orlandini, Mariana; Feier, Flávia Heinz; Jaeger, Brunna; Kieling, Carlos; Vieira, Sandra Gonçalves; Zanotelli, Maria Lucia

doi:10.1016/j.jpedp.2013.08.008

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Abstract

Objective

to evaluate the frequency and factors associated with vascular complications after pediatric liver transplantation.

Method

risk factors were evaluated in 99 patients under 18 years of age with chronic liver disease who underwent deceased donor liver transplantation (DDLT) between March of 1995 and November of 2009 at the Hospital de Clínicas de Porto Alegre, Brazil. The variables analyzed included donor and recipient age, gender, and weight; indication for transplant; PELD/MELD scores; technical aspects; postoperative vascular complications; and survival.

Results

vascular complications occurred in 19 patients (19%). Arterial events were most common, occurred earlier in the postoperative period, and were associated with high graft loss andmortality rates. In the multivariate analysis, the following factors were identified: portal veindiameter ≤ 3mm, donor-to-recipient body weight ratio (DRWR), prolonged ischemic time, and use of arterial grafts.

Conclusion

the choice of treatment depends on the timing of diagnosis; however, in this study, surgical revision or correction produced worse outcomes than percutaneous angioplasty. The reduction of risk factors and early detection of vascular complications are key elements to a successful transplantation.

Keywords:

Thrombosis

Hepatic artery

Portal vein

Morbidity

Mortality

Resumo

Objetivo

avaliar a frequência e os fatores associados a complicações vasculares após transplante hepático pediátrico.

Método

os fatores de risco foram avaliados em 99 pacientes com mais de 18 anos de idade comdoença hepática crônica submetidos a transplante hepático cadavérico (THC) entre marc¸o de1995 e novembro de 2009 no Hospital de Clínicas de Porto Alegre, Brasil. As variáveis analisadasincluíram: idade, sexo e peso dos doadores e receptores; indicac¸ão de transplante; escores PELD/MELD; aspectos técnicos; complicações vascu- lares pós-operatórias; e sobrevida.

Resultados

ocorreram complicações vasculares em 19 pacientes (19%). Os eventos arteriais foram mais comuns, tendo ocorrido precocemente no pós-operatório, e foram associados a altas taxas de perda do enxerto e mortalidade. Em uma análise multivariada, foram identificadosos seguintes fatores: diâmetro da veia porta ≤ 3mm, proporc¸ão de peso do doador/receptor (DRWR), tempo de isquemia prolongado e uso de enxertos arteriais.

Conclusão

A escolha do tratamento depende do momento do diagnóstico; contudo, nessa série, a cirurgia de revisão, ou correc¸ão cirúrgica, produziu resultados piores que a angioplastia per-cutânea. A redução dos fatores de risco e a detecção precoce de complicações vasculares sãofundamentais para um transplante bem-sucedido.

Palavras-chave:

Trombose

Artéria hepática

Veia porta

Morbidez

Mortalidade

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☆

Como citar este artigo: Orlandini M, Feier FH, Jaeger B, Kieling C, Vieira SG, Zanotelli ML. Frequency of and factors associated with vascular complications after pediatric liver transplantation. J Pediatr (Rio J). 2014;90:169-75.

☆☆

Estudo realizado no Grupo de Transplante Hepático Pediátrico, Hospital de Clínicas de Porto Alegre, Brasil.

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