Background

Portal vein complications (PVC) after liver transplantation may compromise patient and graft survival. Due to the rarity of PVC, risk factors are unclear and management strategies differ. This study aims to identify risk factors of PVC and describe management strategies in patients at Primary Children's Hospital.

Methods

This is a retrospective study of pediatric patients transplanted June 2002-May 2023. Data were collected for participation in the PORTAL registry. Retransplants were excluded.

Children with and without PVC were compared using chi-square tests or T-tests. Risk factors were explored with multivariate regression models. Survival curves were compared by the log-rank test.

Results

PVC occurred in 19 of 235 (7.8%) children post-transplant. Children with PVC were younger (<1 year vs. 3 years, p<0.001) and smaller (7.4 kg vs. 14.5 kg, p<0.001) than those without PVC. There was no difference in donor type (deceased vs living; p=0.857) or transplant type (whole vs split; p=0.687). Children with PVC were hospitalized longer than those without PVC (28 days vs. 18 days p=0.002). When adjusting for transplant type, gender, and race/ethnicity, weight (OR:0.91; 95% CI:0.82-0.97, p=0.033) or age (OR:0.75; 95%CI:0.57-0.90, p=0.011) were significant in multivariate analysis. Graft (p=0.73) and patient (p=0.25) survival were similar.

The most common treatments for PVC were conservative treatment (n=10), surgical thrombectomy (n=8), and Meso-Rex bypass (n=3).

Conclusion

Smaller children are at higher risk of PVC. Despite variable management and longer hospitalizations, patient and graft survival are similar to patients without PVC. Limitations include the retrospective design, cohort heterogeneity, and low event frequency.