Purpose: The purpose of this study was to evaluate the prognosis of interventional treatment through inferior mesenteric vein (IMV) and other treatments systemically for acute portal vein thrombosis after pediatric liver transplantation.

Methods and Results: 290 children were involved in this study and there was 9 (3.1%) acute PVT within 24h after pediatric LT. Among these 9 patients, 8 had original disease of biliary atresia and 1 caroli syndrome. Three of them received stent placement through IMV with minimal surgery. The guidewire was inserted into the IMV to obtain main portal venography and portal clots were mechanically fragmented with balloon angioplasty, after which stent was placed. The coronary vein was embolized with metallic coil. The PV flow velocity was restored from 0-7 cm/s (mean, 4.5 cm/s) to 22-42 cm/s (mean, 33.3 cm/s). 2 patients (66.7%) kept PV patent and were alive at the end of follow-up. All stents were self-expandable and no stent related complications occurred to them. 2 patients having small volume thrombosis without obvious change in PV flow or PV hypertension symptoms restored the patency of PV using conservative treatments. Urokinase and heparin was administered during thrombolysis and no related complications occurred during the treatment. 3 patients received thrombectomy but all of them finally died for liver failure or infection, even 2 of them kept PV patent after thrombosis being removed.

Conclusion: Our experience has revealed that interventional treatment through IMV is a safe and effective way to treat acute PVT after pediatric LT, companying with less complications and better prognosis. In addition, for PVT patients without significant change of PV flow or PV hypertension symptoms, conservative management could be a recommended option with good prognosis and less pain.

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