Abstract

After a liver transplant, portal vein thrombosis (PVT) can occur at any time. In cases of thrombosis following liver transplantation, we discuss our experience with portal vein recanalization. Twenty-eight children, or 5% of the 566 recipients of a liver transplant, underwent transmesenteric portal vein recanalization. All of the children had left hepatic segments, developed PVT, and displayed portal hypertension symptoms or signs. In all instances, the transmesteric route was used for portal vein recanalization. Twenty-two patients (78.6%) had their recanalization and stent placement performed successfully. After the procedure, they received oral anticoagulants, and their clinical symptoms subsided. In seven patients, portal vein restenosis or thrombosis caused symptoms to return. The proposed treatment had a success rate of 60.7% on an intention-to-treat basis. At the conclusion of the study period, only 17 out of 28 children with posttransplant chronic PVT maintained primary and assisted stent patency. The transmesenteric approach via minilapa rotomy is technically possible with favorable clinical and hemodynamic outcomes in cases of portal vein obstruction. It is an alternative procedure that can be performed in some cases to reestablish portal flow to the liver graft. It is also a therapeutic addition to other treatments for chronic PVT.