Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty

We reviewed the early results of percutaneous portal venoplasty as a method of treating portal vein stenosis in 11 children with reduced-size liver transplants. Percutaneous transhepatic portal venoplasty was attempted in 11 children with portal vein stenoses over a period of 9 months. The venoplasty was performed by direct puncture of an intrahepatic portal vein followed by balloon angioplasty of the stenotic segment. Patients presented with symptoms of portal venous hypertension or were identified by routine surveillance with posttransplant Doppler sonography. All stenoses were verified with angiography before portal venoplasty was attempted. In patients with suboptimal results after portal venoplasty or who developed recurrent stenoses, intravascular stents were placed across stenoses. In eight of 11 patients, initial clinical and technical success was achieved. Intravascular stents were placed in two of these patients. In the three unsuccessful procedures, complete occlusion of the portal vein precluded vascular access. Two procedure-related complications and one nonprocedure-related complication developed. In one patient, the portal vein restenosed after 6 months, and a metallic intravascular stent was placed to alleviate the stenosis. Portal vein patency in all other successful procedures has been maintained for 3-9 months (mean, 6.1 months) without further intervention. Percutaneous transhepatic portal venoplasty of portal vein stenosis in children with living, related liver transplant donors has excellent early results. In patients with this complication, the procedure has become the initial choice in our hospital, eliminating the need for surgical revision, portacaval shunting, or retransplantation.