Pediatr Transplantation 2015: 19: 18–26
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Pediatric Transplantation DOI: 10.1111/petr.12407
Review Article
Current state of the art in management of vascular complications after pediatric liver transplantation Kamran Hejazi Kenari S, Mirzakhani H, Eslami M, Saidi RF. (2015) Current state of the art in management of vascular complications after pediatric liver transplantation. Pediatr Transplant, 19: 18–26. DOI: 10. 1111/petr.12407. Abstract: Vascular complications by compromising the blood flow to the allograft can have significant and sometimes life-threatening consequences after pediatric liver transplantation. High level of suspicion and aggressive utilization of diagnostic modalities can lead to early diagnosis and salvage of the allograft. This review will summarize the current trends in management of vascular complications after pediatric liver transplantation.
Seyed Kamran Hejazi Kenari1, Hooman Mirzakhani1, Mohammad Eslami2 and Reza F. Saidi1 1
Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA, 2Division of Vascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA Key words: liver transplantation – pediatrics – endovascular – outcomes Reza F. Saidi, Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA Tel: (401) 444-3250 Fax: (401) 444-3283 E-mail: [email protected] Accepted for publication 31 October 2014
Liver transplantation is the treatment of choice in children with end-stage liver failure. There are currently 1741 pediatric patients on the waiting list for solid organ transplantation in the United States, including 465 for liver transplantation. More than 40 000 children have been transAbbreviations: D/R, donor to recipient; DDLT, deceased donor liver transplantation; EP, endovascular procedures; HA, hepatic artery; HAK, hepatic artery kinks; HAP, hepatic artery pseudoaneurysm; HAS, hepatic artery stenosis; HAT, hepatic artery thrombosis; HCC, hepatocellular carcinoma; HV, hepatic vein; HVS, hepatic vein stenosis; HVT, hepatic vein thrombosis; IAT, intra-arterial thrombolysis; LDLT, living donor liver transplantation; LFT, liver function tests; LT, liver transplantation; NPV, negative predictive value; PPV, positive predictive value; PTA, percutaneous transluminal angioplasty; PVS, portal vein stenosis; PVT, portal vein thrombosis; tACE, transarterial chemoembolization.
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planted in the United States, which consists of 7.4% of all transplantations. The number of organ transplantations in children has increased about 50% from 1988 to 2011. The biggest challenge in organ transplantation is organ shortage (1). One solution for organ shortage is pediatric partial living-related liver transplantation, which was first performed in Brazil in 1988 (2) and then in Australia (3) and Japan (4). Based on OPTN data, five-yr patient survival rate has increased to 76.5%, 76.6%, 85.5%, and 80.6% for children
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Pediatric Transplantation DOI: 10.1111/petr.12407
Review Article
Current state of the art in management of vascular complications after pediatric liver transplantation Kamran Hejazi Kenari S, Mirzakhani H, Eslami M, Saidi RF. (2015) Current state of the art in management of vascular complications after pediatric liver transplantation. Pediatr Transplant, 19: 18–26. DOI: 10. 1111/petr.12407. Abstract: Vascular complications by compromising the blood flow to the allograft can have significant and sometimes life-threatening consequences after pediatric liver transplantation. High level of suspicion and aggressive utilization of diagnostic modalities can lead to early diagnosis and salvage of the allograft. This review will summarize the current trends in management of vascular complications after pediatric liver transplantation.
Seyed Kamran Hejazi Kenari1, Hooman Mirzakhani1, Mohammad Eslami2 and Reza F. Saidi1 1
Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA, 2Division of Vascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA Key words: liver transplantation – pediatrics – endovascular – outcomes Reza F. Saidi, Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA Tel: (401) 444-3250 Fax: (401) 444-3283 E-mail: [email protected] Accepted for publication 31 October 2014
Liver transplantation is the treatment of choice in children with end-stage liver failure. There are currently 1741 pediatric patients on the waiting list for solid organ transplantation in the United States, including 465 for liver transplantation. More than 40 000 children have been transAbbreviations: D/R, donor to recipient; DDLT, deceased donor liver transplantation; EP, endovascular procedures; HA, hepatic artery; HAK, hepatic artery kinks; HAP, hepatic artery pseudoaneurysm; HAS, hepatic artery stenosis; HAT, hepatic artery thrombosis; HCC, hepatocellular carcinoma; HV, hepatic vein; HVS, hepatic vein stenosis; HVT, hepatic vein thrombosis; IAT, intra-arterial thrombolysis; LDLT, living donor liver transplantation; LFT, liver function tests; LT, liver transplantation; NPV, negative predictive value; PPV, positive predictive value; PTA, percutaneous transluminal angioplasty; PVS, portal vein stenosis; PVT, portal vein thrombosis; tACE, transarterial chemoembolization.
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planted in the United States, which consists of 7.4% of all transplantations. The number of organ transplantations in children has increased about 50% from 1988 to 2011. The biggest challenge in organ transplantation is organ shortage (1). One solution for organ shortage is pediatric partial living-related liver transplantation, which was first performed in Brazil in 1988 (2) and then in Australia (3) and Japan (4). Based on OPTN data, five-yr patient survival rate has increased to 76.5%, 76.6%, 85.5%, and 80.6% for children
