*Purpose: Portal vein (PV) anomalies and portal vein thrombosis (PVT) can present as challenging cases in the pediatric cohort, necessitating analysis and an algorithmic approach.

*Methods: We reviewed the records of liver transplant operations performed at Children’s Hospital Los Angeles from 2004-2020. The incidence of PVT, portal vein atresia (PVA), and portal vein hypoplasia (PVH), operative management, and post-operative outcomes were analyzed retrospectively.

*Results: 333 LTs were performed. 32 LTs in 31 recipients had challenging PV anomalies. 17 patients (5%) had a primary PVT (4 grade 1, 10 grade 2, 2 grade 3, 1 grade 4). 13 patients had PVH without primary PVT. There was no statistically significant difference in post-operative PV complications between patients with challenging PVs managed with and without a cadaveric venous graft (CVG) – (11% (3/27) vs. 0% (0/8); p=1.00). There were no statistically significant differences in re-operation for bleeding, length of stay, patient or graft survival between patients with challenging PV anomalies managed with and without CVG (patient survival 92% vs. 100%, p = 0.43); (graft survival 89% vs. 100%; p = 0.33).

*Conclusions: PVT, PVA, and PVH can present as challenging cases in pediatric LT. A primary construct with or without thrombectomy should be utilized when amenable. However, many circumstances arise when thrombectomy is inadequate, or the native vessel itself is of critically small caliber. As we have shown, such instances can safely and successfully be managed utilizing a CVG with excellent outcomes.

« Back to 2022 American Transplant Congress