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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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COMMENTARY
Year : 2015  |  Volume : 20  |  Issue : 3  |  Page : 127
 

Review of article: Vascular complications in biliary atresia patients undergoing living donor liver transplantation: Analysis of 110 patients over 10 years


Director and Senior Consultant Pediatric Surgeon/Urologist, Head of Solid Organ Transplantation Program, Narayana Hrudayalaya Woman and Child Institute, Bangalore - 560099, Karnataka, India

Date of Web Publication18-Jun-2015

Correspondence Address:
Ashley D'Cruz
Director and Senior Consultant Pediatric Surgeon/Urologist, Head of Solid Organ Transplantation Program, Narayana Hrudayalaya Woman and Child Institute, Bangalore - 560099, Karnataka
India
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Source of Support: None, Conflict of Interest: None


PMID: 26166982

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How to cite this article:
D'Cruz A. Review of article: Vascular complications in biliary atresia patients undergoing living donor liver transplantation: Analysis of 110 patients over 10 years. J Indian Assoc Pediatr Surg 2015;20:127

How to cite this URL:
D'Cruz A. Review of article: Vascular complications in biliary atresia patients undergoing living donor liver transplantation: Analysis of 110 patients over 10 years. J Indian Assoc Pediatr Surg [serial online] 2015 [cited 2019 Nov 15];20:127. Available from: http://www.jiaps.com/text.asp?2015/20/3/127/159018


The retrospective study is of a fairly large group of children undergoing living donor liver transplant for biliary atresia the majority, following a failed Kasai portoenterostomy. Live donor liver transplantation presents many technical challenges especially in children with biliary atresia. The incidence of hepatic artery thrombosis may vary widely, 4.7-25%. Early restitution will ensure graft survival and avoid biliary complications. In our series of 60 children, we have an incidence of 8.3% all occurring in children transplanted for biliary atresia. The most commonly used left lateral segment graft, usually has a small donor artery to be anastomosed to a hypertrophied recipient vessel that may lead to a size mismatch or kinking. Many centers have moved to microvascular techniques to perform the arterial anastomosis with better results. Prompt recognition and early correction by re-anastomosis or by interventional radiology techniques are often successful.

The portal vein in children with BA is often hypoplastic and diseased, having intramural thrombi or intimal inflammation. Portal vein velocity also is often diminished in this group of children due to steal effect from collateral shunts and these may have to be interrupted to have a better flow. This is more so in large for size grafts. The survival of the graft in acute portal vein thrombosis will require urgent revascularization. [1] Our incidence for acute thrombosis has been 5%, 2 of the 3 children had biliary atresia. Direct re-anastomosis after thrombectomy is often successful as noted by the authors and will ensure graft survival in the long-term. We used and interposition internal jugular graft from the superior mesenteric vein to the donor portal vein in one of our children with success.

Outflow issues are less common and may be avoided by ensuring a large anastomosis of the hepatic vein and proper positioning of the graft. Late stenosis is more common and will respond to interventional procedures.

 
   References Top

1.
Shibasaki S, Taniguchi M, Shimamura T, et al. Risk factors for portal vein complications in Pediatric living donor transplantation. Clinical Transplantation 2010; 24:550-6.  Back to cited text no. 1
    




 

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