131 - Safety and Efficacy of Hepatic Vein Angioplasty Post Pediatric Liver Transplantation

To determine the efficacy and safety of hepatic vein angioplasty in a clinical post-liver transplant pediatric population

Materials and Methods:

The clinical data and imaging of pediatric liver transplant patients who underwent hepatic venous outflow angioplasty between 2011 and 2022 were analyzed. Technical success was defined as gradient across hepatic outflow stenosis less than 5 mmHg. In cases without pressure measurements, this was defined by pre-and post-angioplasty percent stenosis as measured from venography images. Clinical success was defined as improvement or resolution of indication for intervention con follow-up imaging or laboratory results. Statistical analysis was performed using paired t-test. Post-procedural complications were also analyzed.

Results:

27 procedures were performed on 10 patients (5 male, mean age of 13.0, range [14 months, 24 years]). Indications included ascites (77.8%), laboratory abnormalities (i.e. hypoalbuminemia or hyperbilirubinemia, 29.6%), or imaging findings of stenosis (22.2%).

 Pre- and post-angioplasty measurements were present in 17 cases. Mean pre-angioplasty gradient was 7.4 mmHg and mean post-angioplasty gradient was 3.3 mmHg, with a mean difference of 4.2 mmHg (p=0.0007). In the remaining nine cases without pressure measurements, the mean pre-angioplasty stenosis was 61.4%, which decreased to a mean 28.7% post-angioplasty, for a mean difference of 32.7% (p=0.0001). Technical success rate was 92.6%. Clinical success was present in 74.3% of cases. Two post-procedural complications were recorded (7.0%) – one case of bacterial peritonitis and one case of self-resolved bleeding at access site.

Conclusion:

Hepatic vein angioplasty is a safe and efficacious treatment method of post-transplant hepatic vein stenosis in a pediatric population. While post-transplant percutaneous vascular interventions are well-documented in adults, more research is needed in the pediatric demographic. This treatment is particularly pertinent for children, who are more susceptible to vascular complications due to size mismatches from split liver transplants. Moreover, stent placement is typically avoided in pediatric patients to prevent complications in future surgeries or procedures.