Introduction: Portal vein stenosis (PVS) is a serious complication after pediatric liver transplantation (pLT) requiring revascularization. While percutaneous transluminal angioplasty (PTA) and endovascular stent placement offer less invasive alternatives to surgery, their long-term outcomes remain unclear. This study aims to determine their efficacy and safety.
Methods: The study analyzed PTA and stent procedures (n>10) for PVS after pLT from the PORTAL registry, which comprises of a 20-year cohort from 21 centers across 18 countries. Outcome measures included technical success, adverse events (<30 days postprocedural), and long-term portal vein patency obtained with, and without adjuvant treatment.
Results: Among 239 patients with PVS, 207 underwent primary endovascular treatment (181 PTA, 26 stent), achieving technical success rates of 97% and 89% respectively (p=0.089). Adverse events did not differ (p>0.050), including bleeding (5%), thrombosis (3%), infection (4%), reintervention (2%), no retransplantation, death (0.5%) and other (3%). One-year patency rates were 75% for PTA and 84% for stents. Adjuvant secondary treatment after PTA was performed in 56 patients (1 conservative, 5 surgical, 50 endovascular) and in 5 patients after stenting (1 conservative, 4 endovascular). After PTA, secondary treatment with re-PTA achieved 78% one-year patency (n=35), while secondary stenting had a 100% patency rate (n=12, p=0.085). Over a 10-year follow-up, 97% of primarily PTA-treated vessels, and 100% of primarily stented vessels maintained patency or had it restored with adjuvant treatment (p=0.978).
Conclusions: PTA and stent placement demonstrate excellent safety and efficacy, even as reinterventions. Given its minimally invasive nature, PTA is a particularly favorable modality for addressing PVS after pLT.