Portal vein thrombosis in biliary atresia patients after living donor liver transplantation

Background: Vascular complications are major complications after living donor liver transplantation (LDLT), especially in biliary atresia (BA). Early diagnosis and treatment of portal vein thrombosis (PVT) may ensure optimal graft function and good recipient survival. Our aim was to find any association between pre- and post-transplant anatomic characteristics and hemodynamics, and the occurrence of post-transplant PVT in BA patients undergoing LDLT. Methods: We evaluated the pre- and post-transplant findings in ultrasonography in 105 BA recipients who underwent primary LDLT to determine the possible associated factor(s) and ultrasonographic warning sign(s) that may cause PVT development after LDLT. Results: There were 53 male and 52 female recipients. The mean age, height, and weight were 2.8 years, 83.6 cm, and 12.5 kg, respectively. Occlusion of the portal vein (PV) developed in 8 patients. On multivariate analysis, the only independent, pretransplant risk factor predisposing to PV occlusion post-transplant was small main PV size (P = .008). Post-transplant ultrasonographic warning signs included PV flow <10 cm/sec (P = .003), high hepatic artery flow >70 cm/sec (P = .027), and lesser hepatic artery resistance index <0.65 (P = .013). Both slow PV flow <10 cm/sec and lesser hepatic artery resistance index have high sensitivity and specificity in predicting post-LDLT PVT. Conclusion: Small PV size (<4 mm) and slow portal flow <10 cm/sec combined with lesser hepatic artery resistance index (<0.65) are strong warning signs that may predict the development of post-LDLT PVT in BA patients that require close monitoring.