Document Type

Article

Publication Date

5-26-2025

Identifier

DOI: 10.1002/hsr2.70625; PMCID: PMC12106351

Abstract

BACKGROUND AND AIMS: Portal vein obstruction (PVO) is a known complication after pediatric liver transplantation (pLT). Effective management strategies are crucial in improving patient outcomes. This study investigated the various practice patterns related to PVO management to clarify the degree of consensus on the diverse facets of care involved in addressing PVO after pLT.

METHODS: A self-reported evaluation was conducted using a scanned, paper-based survey among specialized pLT centers participating in the Portal vein Obstruction Revascularization Therapy After Liver transplantation (PORTAL) registry. The survey consisted of 30 questions covering the current practices regarding PVO, including experience, team composition, follow-up and screening protocol, assessment criteria, postprocedural care, and radiologic follow-up.

RESULTS: The survey was returned by 25 centers (100%) from different regions worldwide. All centers used Doppler ultrasound (DUS) for PVO screening in the outpatient department. Noninvasive diagnostic criteria used during DUS assessment included anastomotic velocity (50%) and anastomotic-to-pre-anastomotic velocity ratio (54%). Digital subtraction angiography was used by 79% of respondents to diagnose portal vein anastomosis stenosis, which led to diagnostic cutoff values including a narrowing of the visual aspect of the anastomosis of ≥ 50% (80%) and a pressure gradient ≥ 5 mmHg (50%). PTA was identified as a standard treatment for PVO. A remarkable heterogeneity was observed in postinterventional anticoagulation and surveillance protocols.

CONCLUSIONS: The care for PVO after pLT lacks standardization, resulting in substantial variation across healthcare centers. There is a need to establish a clear consensus on PVO management after pLT to guarantee optimal care.

Journal Title

Health Sci Rep

Volume

8

Issue

5

First Page

70625

Last Page

70625

PubMed ID

40432701

Keywords

liver transplantation; pediatrics; portal vein; vascular patency

Comments

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Publisher's Link: https://onlinelibrary.wiley.com/doi/10.1002/hsr2.70625

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