Portal Vein Thrombosis in Pediatric Liver Transplantation With Technical Variant Grafts: An International Multicenter Analysis of Risk and Prognostic Factors.
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Wang Kaihang, Madadi-Sanjani Omid, Liu Yuan, Raptis Dimitri A, Gunasekaran Vasanthakumar, Rammohan Ashwin, Sakamoto Seisuke, Uchida Hajime, Kaliciński Piotr, Goldaracena Nicolas, van Beekum Cornelius J, Krendl Felix J, Chen Itsuko Chih-Yi, Domenick Bryanna N, Kow Alfred, Soejima Yuji, Furuya Katryn N, Mazariegos George V, Mali Vidyadhar Padmakar, Dunn Stephen, Olthoff Kim, Rand Elizabeth B, Leipnitz Ian, Chen Chao-Long, Balci Deniz, Kirimker Elvan Onur, Nadalin Silvio, Schneeberger Stefan, Sudan Debra L, Schmelzle Moritz, Herden Uta, Fischer Lutz, Sayed Blayne A, Ng Vicky L, Kowalewski Grzegorz, Kasahara Mureo, Rela Mohamed, Broering Dieter C, Xia Qiang, Clavien Pierre-Alain, Li Zhihao
Аннотация
METHODS: A total of 3137 pediatric patients from 19 centers were included: 470 received split/reduced deceased donor grafts and 2667 received living donor grafts. Multivariable logistic regression was used to identify risk factors, whereas time-dependent Cox models were used to assess the impact on survival.
RESULTS: PVT occurred in 102 patients (3.3%) and was associated with increased mortality (adjusted hazard ratio, 2.86; 95% confidence interval [CI], 1.13-7.25; P = 0.027) and graft loss (adjusted hazard ratio, 9.97; 95% CI, 4.90-20.3; P < 0.001). Risk factors included younger age, lower weight, higher Pediatric End-Stage Liver Disease score, longer cold ischemia and operation times, higher graft-to-recipient weight ratio, increased red blood cell transfusions, and biliary atresia. After adjusting for center, lower weight (odds ratio, 0.84 per kg; 95% CI, 0.71-1.00; P = 0.047) and biliary atresia (odds ratio, 2.34; 95% CI, 1.10-5.00; P = 0.027) remained predictors. Five-year patient (88.4% versus 93.1%) and graft survival (82.7% versus 96.3%) were significantly inferior in patients with PVT.
CONCLUSIONS: Low-weight children with biliary atresia constituted a high-risk group, highlighting the necessity for early detection and management.