Longitudinal portoplasty for hypoplasic portal veins in children with biliary atresia requiring a liver transplant: Our experience

Abstract

Background: Patients with biliary atresia (BA) and portal hypoplasia have a higher risk of developing portal complications. The objective of this work is to analyze the results before and after the implementation of longitudinal portoplasty (LP) during liver transplantation (LT) in our center. Methods: Retrospective cohort study including all pediatric patients transplanted due to BA with portal hypoplasia was conducted. Results were analyzed before and after the introduction of the LP in 2016. Primary endpoints were the occurrence of early portal vein thrombosis and portal vein thrombosis. Secondary endpoints were patient survival and portal complications. Results: 60 patients were transplanted before the implementation of LP and 60 patients after the new technique was used. Baseline characteristics did not differ among groups. Portal vein thrombosis decreased from 26.7 % in the first period, to 3.3 % in the second (p 0.001), and early portal thrombosis from 20 % to 1.7 % (p 0.002). An association was found between portal vein thrombosis and the period in which LP was implemented (OR 0.095, 95 %CI 0.021 0.43, p=0.002), showing a lower risk in the occurrence of thrombosis in the second period. Patient survival at 12 and 24 months in the first group was 79.6 % and 76.0 %, while in the second group was 93.1 % and 93.1 %, with a log rank test 0.01. Conclusions: The routine use of LP could possibly minimize the occurrence of portal complications and could be considered in these cases with good results. Level of evidence: II.

Keywords

• Pediatric liver transplantation
• Longitudinal portoplasty
• Portal vein anastomosis
• Hypoplasic portal veins
• Biliary atresia
• Surgical technique