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

Informação do artigo

Estatísticas

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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Referências

[1]

P. Jara, L. Hierro.

Childhood liver transplantation Long term results.

Gastroenterol Hepatol., 33 (2010), pp. 398-410

http://dx.doi.org/10.1016/j.gastrohep.2009.11.004 | Medline

[2]

T.L. Huang, Y.F. Cheng, T.Y. Chen, L.L. Tsang, H.Y. Ou, C.Y. Yu, et al.

Doppler ultrasound evaluation of postoperative portal vein stenosis in adult living donor liver transplantation.

Transplant Proc., 42 (2010), pp. 879-881

http://dx.doi.org/10.1016/j.transproceed.2010.02.036 | Medline

[3]

Y. Uchida, S. Sakamoto, H. Egawa, K. Ogawa, Y. Ogura, K. Taira, et al.

The impact of meticulous management for hepatic arterythrombosis on long-term outcome after pediatric living donor liver transplantation.

Clin Transplant., 23 (2009), pp. 392-399

http://dx.doi.org/10.1111/j.1399-0012.2008.00924.x | Medline

[4]

L. Suzuki, I.R. de Oliveira, A. Widman, N.E. Gibeli, F.C. Carnevale, J.G. Maksoud, et al.

Real-time and Doppler US after pediatric segmental liver transplantation: I. portal vein stenosis.

Pediatr Radiol., 38 (2008), pp. 403-408

http://dx.doi.org/10.1007/s00247-007-0733-5 | Medline

[5]

C.K. Oh, S.J. Pelletier, R.G. Sawyer, A.R. Dacus, C.S. McCullough, T.L. Pruett, et al.

Uni- and multi-variate analysis of risk factors for early and late hepatic artery thrombosis after liver transplantation.

Transplantation., 71 (2001), pp. 767-772

Medline

[6]

W. Hardikar, U. Poddar, J. Chamberlain, S. Teo, R. Bhat, B. Jones, et al.

Evaluation of a post-operative thrombin inhibitor replacement protocol to reduce haemorrhagic and thrombotic complications after paediatric liver transplantation.

Thromb Res., 126 (2010), pp. 191-214

http://dx.doi.org/10.1016/j.thromres.2010.05.015 | Medline

[7]

J.P. Duffy, J.C. Hong, D.G. Farmer, R.M. Ghobrial, H. Yersiz, J.R. Hiatt, et al.

Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients.

J Am Coll Surg., 208 (2009), pp. 896-903

http://dx.doi.org/10.1016/j.jamcollsurg.2008.12.032 | Medline

[8]

J.L. Fernandez Aguilar, M.A. Suarez-Munoz, J. Santoyo Santoyo, B. Sánchez Pérez, A. Pérez Daga, C.P. Ramírez Plaza, et al.

Aggressive management of the arterial complications of liver transplantation Impact upon survival and biliary complications.

Cir Esp., 87 (2010), pp. 155-158

http://dx.doi.org/10.1016/j.ciresp.2009.11.011 | Medline

[9]

M.L. Zanotelli, S. Vieira, R. Alencastro, C. Kieling, I. Leipnitz, C. Ferreira, et al.

Management of vascular complications after pediatric liver transplantation.

Transplant Proc., 36 (2004), pp. 945-946

http://dx.doi.org/10.1016/j.transproceed.2004.03.104 | Medline

[10]

J. Bekker, S. Ploem, K.P. de Jong.

Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors.

Am J Transplant., 9 (2009), pp. 746-757

http://dx.doi.org/10.1111/j.1600-6143.2008.02541.x | Medline

[11]

Y. Takahashi, Y. Nishimoto, T. Matsuura, M. Hayashida, T. Tajiri, Y. Soejima, et al.

Surgical complications after living donor liver transplantation in patients with biliary atresia: a relatively high incidence of portal vein complications.

Pediatr Surg Int., 25 (2009), pp. 745-751

http://dx.doi.org/10.1007/s00383-009-2430-y | Medline

[12]

O. Jean-Bernard.

Approach to avoid and to manage vascular thrombosis and stenosis in pediatric liver transplantation.

Pediatr Transplant., 11 (2007), pp. 124-126

http://dx.doi.org/10.1111/j.1399-3046.2006.00642.x | Medline

[13]

J.S. Neto, R. Pugliese, E. Fonseca, R. Vincenzi, V. Pugliese, H. Candido, et al.

Four hundred thirty consecutive pediatric living donor liver transplants: variables associated with post transplant patient and graft survival.

Liver Transplant., 18 (2012), pp. 577-584

[14]

G. Moray, F. Boyvat, S. Sevm, F. Karakayali, I. Ayvaz.

Dalgic¸ A, et al.

Vascular complications after liver transplantation in pediatric patients. Transplant Proc., 37 (2005), pp. 3200-3202

[15]

M. Ueda, F. Oike, M. Kasahara, Y. Ogura, K. Ogawa, H. Haga, et al.

Portal vein complications in pediatric living donor liver transplantation using left-side grafts.

Am J Transplant., 8 (2008), pp. 2097-2105

http://dx.doi.org/10.1111/j.1600-6143.2008.02360.x | Medline

[16]

J.I. Moon, G.O. Jung, G.S. Choi, J.M. Kim, M. Shim, E.Y. Kim, et al.

Risk factors for portal vein complications after pediatric living donor liver transplantation with left-sided grafts.

Transplant Proc., 42 (2010), pp. 871-875

http://dx.doi.org/10.1016/j.transproceed.2010.02.059 | Medline

[17]

Y. Kawano, K. Mizuta, Y. Sugawara, S. Egami, S. Hisikawa, Y. Sanada, et al.

Diagnosis and treatment of portal vein stenosis after living donor liver transplantation.

Transpl Int., 22 (2009), pp. 1151-1158

http://dx.doi.org/10.1111/j.1432-2277.2009.00932.x | Medline

[18]

S. Shibasaki, M. Taniguchi, T. Shimamura, T. Suzuki, K. Yamashita, K. Wakayama, et al.

Risk factors for portal vein complications in pediatric living donor liver transplantation.

Clin Transplant., 24 (2010), pp. 550-556

http://dx.doi.org/10.1111/j.1399-0012.2009.01123.x | Medline

[19]

D. Broniszczak, M. Szymczak, A. Kaminski, A. Chyzynska, H. Ismail, T. Drewniak, et al.

Vascular complications after pediatric liver transplantation from the living donors.

Transplant Proc., 38 (2006), pp. 1456-1458

http://dx.doi.org/10.1016/j.transproceed.2006.02.094 | Medline

[20]

Z.A. Stewart, J.E. Locke, D.L. Segev, N.N. Dagher, A.L. Singer, R.A. Montgomery, et al.

Increased risk of graft loss from hepatic artery thrombosis after liver transplantation with older donors.

Liver Transpl., 15 (2009), pp. 1688-1695

http://dx.doi.org/10.1002/lt.21946 | Medline

[21]

M.A. Silva, P.S. Jambulingam, B.K. Gunson, D. Mayer, J.A. Buckes, D.F. Mirza, et al.

Hepatic artery thrombosis following orthotopic liver transplantation: a 10-year experience from a single centre in the United Kingdom.

Liver Transpl., 12 (2006), pp. 146-151

http://dx.doi.org/10.1002/lt.20566 | Medline

[22]

A.N. Backes, N.E. Gibelli, A.C. Tannuri, M.M. Santos, M.L. Pinho-Apezzato, A.C. Andrade, et al.

Hepatic artery graft in pediatric liver transplantation: single-center experience with 58 cases.

Transplant Proc., 43 (2011), pp. 177-180

http://dx.doi.org/10.1016/j.transproceed.2010.11.006 | Medline

[23]

E. Pareja, M. Cortes, R. Navarro, F. Sanjuan, R. Lopez, J. Mir.

Vascular complications after orthotopic liver transplantation: hepatic artery thrombosis.

Transplant Proc., 42 (2010), pp. 2970-2972

http://dx.doi.org/10.1016/j.transproceed.2010.07.063 | Medline

[24]

P.A. Sheiner, C.V. Varma, J.V. Guarrera, J. Cooper, M. Garatti, S. Emre, et al.

Selective revascularization of hepatic artery thrombosis after liver transplantation improves patient and graft survival.

Transplantation., 64 (1997), pp. 1295-1299

Medline

[25]

B.W. Kim, J.H. Won, B.M. Lee, B.H. Ko, H.J. Wang, M.W. Kim.

Intraarterial thrombolytic treatment for hepatic artery thrombosis immediately after living donor liver transplantation.

Transplant Proc., 38 (2006), pp. 3128-3131

http://dx.doi.org/10.1016/j.transproceed.2006.08.164 | Medline

[26]

J.C. Coelho, J.E. Matias, M.B. Parolin, E.L. Martins, P.R. Salvallagio, C.G. Gonçalves.

Complicações vasculares pós-transplante hepático.

Rev Col Bras Cir., 27 (2000), pp. 378-382

[27]

A. Jain, G. Costa, W. Marsh, P. Fontes, M. Devera, G. Mazariegos, et al.

Thrombotic and nonthrombotic hepatic artery complications in adults and children following primary liver transplantation with long-term follow-up in 1000 consecutive patients.

Transpl Int., 19 (2006), pp. 27-37

http://dx.doi.org/10.1111/j.1432-2277.2005.00224.x | Medline

[28]

F. Alvarez.

Portal vein complications after pediatric liver transplantation.

Curr Gastroenterol Rep., 14 (2012), pp. 270-274

http://dx.doi.org/10.1007/s11894-012-0257-5 | Medline

[29]

D. Kelly.

Liver transplantation in children.

J Pediatr (Rio J)., 84 (2008), pp. 381-382

☆

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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