P4 Stump Approach for Intraoperative Portal Vein Stenting in Pediatric Living Donor Liver Transplantation

Chao Long Chen*, Yu Fan Cheng, Viola Huang, Ting Lung Lin, Yi Chia Chan, Hsin You Ou, Chee Chien Yong, Shih Ho Wang, Chih Che Lin

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

19 Scopus citations

Abstract

Objective: The aim of this study was to evaluate the utility of the P4 stump stenting approach for treating portal vein (PV) complications in pediatric living donor liver transplantation (LDLT). Background: PV complications cause significant morbidity and mortality in pediatric LDLT. Biliary atresia in the backdrop of pathological PV hypoplasia and sclerosis heightens the complexity of PV reconstruction. The authors developed a novel approach for intraoperative PV stenting via the graft segment 4 PV stump (P4 stump) to address this challenge. Methods: From April 2009 to December 2016, 15 pediatric LDLT recipients (mean age 10.3 ± 5.0 months, mean graft-recipient weight ratio 3.70%) underwent intraoperative stenting for suboptimal PV flow (<10 cm/s) or PV occlusion after collateral ligation and graft repositioning. Under portography, metallic stents were deployed via the reopened P4 stump of the left lateral segment grafts. Results: PV diameter and peak flow increased significantly after stent placement (2.93 ± 1.74 to 7.01 ± 0.91 mm and 2.0 ± 9.2 to 17.3 ± 3.5 cm/s, respectively, P = 0.001 for both), and there were no technical failures. Stents in all surviving patients remained patent up to 8 years (mean 27.7 months), with no vascular or biliary complications. After implementation of the P4 approach, the incidence of variceal bleeding as a late complication decreased from 7% to zero. Conclusion: The P4 stump stenting approach affords procedural convenience, ease of manipulation, and consistent results with the potential for excellent long-term patency in children despite continued growth. This technique obviates the need for more demanding post-transplant stenting, and may become a substitute for complicated revision surgery, portosystemic shunting, or retransplantation.

Original languageEnglish
Pages (from-to)e42-e44
JournalAnnals of Surgery
Volume267
Issue number3
DOIs
StatePublished - 01 03 2018

Bibliographical note

Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • Biliary atresia
  • inferior mesenteric vein
  • living donor liver transplantation
  • portal vein complication
  • portal vein stent
  • segment 4 portal vein stump

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