347 - Portal Vein Angioplasty Outcomes After Pediatric Technical Variant Liver Graft Transplantation: Single-Center Experience

Purpose: Portal vein stenosis (PVS) represents a significant vascular complication following pediatric technical variant liver graft ("split-liver") transplantation. Pediatric recipients face heightened risk due to size mismatch between small recipients and technical variant grafts, often requiring vein grafts for reconstruction. Small caliber pediatric vessels, weight less than 7 kg, and complex anastomoses predispose to stenosis. This study evaluated the results of portal vein interventions for clinically significant PVS in pediatric technical variant liver recipients.

Materials and Methods: This is a single-institution retrospective review of pediatric technical variant transplants (TVLT) from 2000 to the present. A total of 160 transplants were analyzed. PVS was defined by elevated portal flow velocities, CT evidence of stenosis, and clinical findings of portal hypertension. Variables analyzed included donor type, recipient weight, anastomosis type, time to intervention, pressure gradients, repeat treatments, access route, and complications.

Results: Twelve patients (7.5%) developed clinically significant PVS. The average patient age was 12 months (ranging from 5 to 24 months), except for one 8-year-old. Twenty-two procedures were performed with a 91% technical success rate. The mean time to intervention was 459 days. Angioplasty was performed in 18 out of 22 procedures, and stenting in 4 out of 22. The mean trans-stenotic gradient decreased from 8.65 mmHg to 1 mmHg. Seven complications were managed conservatively. Assisted primary patency was 92%, and patient survival was 100%.

Conclusion: PVS occurred in 7.5% of pediatric technical variant graft transplants in our single-center review. Percutaneous interventions demonstrated excellent technical success (91%) and patency (92%) with low morbidity. Early intervention provides effective treatment with excellent outcomes, supporting interventional management as the first-line therapy for PVS in this population.