Introduction: Vascular complications are among the most important causes of increased mortality and morbidity in the early postoperative period after liver transplantation. Especially in pediatric recipients, small vessel diameters, and vessel diameter mismatch between donor and recipient in living donors may lead to undesirable outcomes such as thrombus and anastomotic stenosis.In this study, we aimed to evaluate early vascular complications in pediatric liver transplants.
Methods: From 8 November 1988 to 03 April 2025, we performed 776 LT procedures and 377 of them were pediatric.  All patients were followed up with doppler ultrasonography twice daily during the first week after liver transplantation. In case of any problem on Doppler ultrasonography, CT/angiography with IV contrast was performed. If the general condition of the patient was stable, interventional radiologic methods were tried to solve the vascular problem as a priority. If the patient's condition was not stable or if the problem could not be solved by interventional radiologic methods, the patient was explored.
Results: Mean age of pediatric recipients was 7.34 years (3 months – 17 years). Thirty-nine  (10.3%) of the pediatric LT were deceased donor LT and 338 (89.7%) were living related liver transplant. Most cause of liver failure was biliary atresia (n=183). Mean weight of recipients was 23.3 kg . Most of graft types was left lateral graft (n=231). Hepatic vein complications occurred in 4 patients. In all patients, stenosis was detected in the portal vein anastomosis region and was successfully treated with interventional radiological methods by placing a stent in the anastomosis region. Portal vein complications occurred in 6 patients. In one of these patients, hemostasis was performed by surgical method due to bleeding from the portal vein anastomosis. In the second patient, the anastomosis was surgically revised due to thrombus formation in the portal vein. In the other 4 patients, due to a stenosis of more than 50% in the portal vein anastomosis, a stent was placed stent in the anastomosis region after balloon dilation using interventional radiological methods, and blood flow was successfully maintained. Hepatic artery complications occurred in 57 patients. Hepatic artery thrombosis occurred in 31 hepatic artery stenosis in 15, bleeding from hepatic artery anastomosis in 8, hepatic artery dissection in 2, and pseudoaneurysm in the hepatic artery in 1 patient. 45 of these were treated with interventional radiological methods and 12 of them surgically.
Conclusion: Vascular complications in liver transplants, especially in the early post-transplant period, may lead to impaired hepatic function and graft failure. Especially hepatic artery complications are one of the most important causes of biliary tract complications that will develop in the future. Vascular complications can be successfully treated at an early stage in experienced centers.