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210825

Chronic Hepatic Venous Ischemia Secondary to Venous Outflow Insufficiency Causes Chronic Rejection in Pediatric Liver Transplant Recipients

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Last updated: 04 Jan 2025

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Abstract

Background: Venous ischemia in a closed compartment results in congestion, impeded blood supply, cell death and a cascade of events that involves immune system to remove cellular debris.  
Aim of the Work: To report our experience with chronic hepatic venous ischemia post liver transplant.
Methods: We describe 3 girls and 4 boys with chronic hepatic venous ischemia secondary to chronic hepatic venous outflow insufficiency (CHVOI) post-liver transplant as confirmed by magnetic resonance venography (MRV) and by interventional radiograms.
Results: The mean age at transplantation was 6.75 years. Following transplant, within 8.5±1.7 months they presented with progressive jaundice, ascites and hepatosplenomegaly. Imaging showed features consistent of CHVOI. The percutaneous liver biopsy revealed a picture of predominant chronic rejection and not of venous congestion. They improved clinically following hepatic venous dilation but not with change of type or dose of immuno-suppression. The venous-outflow tightness recurred with unsustained clinical improvement. Two children had stent placement. All others had irreversible progressive course developing end-stage liver disease. All were indicated for re-transplant. Of them 5 died awaiting re-transplant. 
Conclusions: Chronic rejection among our studied children was due to insufficient intraoperative hepatic venous-outflow structural construction. CHVOI in children leads to graft loss and presents as chronic rejection.  CHVOI should be ruled out in any child presenting with chronic rejection. Very generous hepatic venous outflow surgical construction technique should be planned, individualized and secured during liver transplant procedure. Stent placement is life-saving. Changes of immunosuppression medications is ineffective

DOI

10.21608/cupsj.2021.109121.1041

Keywords

Chronic hepatic venous outflow insufficiency (CHVOI), chronic liver allograft rejection, hepatic venous outflow surgical reconstruction, pediatric liver transplantation

Authors

First Name

Magd

Last Name

Kotb

MiddleName

Ahmed

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

magdkotb@kasralainy.edu.eg

City

Cairo

Orcid

https://orcid.org/00

First Name

Mohamed

Last Name

EL Gharib

MiddleName

-

Affiliation

Department of Interventional Radiology, Ain Shams University, Egypt

Email

mohgharibo@hotmail.com

City

Cairo

Orcid

-

First Name

Hesham

Last Name

Abd El Kader

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Email

heshamabdelkader@yahoo.com

City

-

Orcid

-

First Name

Magda

Last Name

El-Monayeri

MiddleName

-

Affiliation

Department of Pathology, Faculty of Medicine, Ain Shams University, Egypt

Email

mmonayeri@yahoo.com

City

Cairo

Orcid

-

First Name

Ahmed

Last Name

El-Hennawy

MiddleName

-

Affiliation

Department of Pathology, Faculty of Medicine, Cairo University, Egypt

Email

elhennawy_ahmed@yahoo.com

City

-

Orcid

-

First Name

Sherif

Last Name

Kaddah

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt

Email

skaddah@hotmail.com

City

-

Orcid

-

First Name

Hend

Last Name

Abd ElBaky

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

hend.elhossainy@gmail.com

City

-

Orcid

0000-0001-9319-530X

First Name

Nazira

Last Name

Abdalla

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

nzanezo@hotmail.com

City

-

Orcid

-

First Name

Radwa

Last Name

Shamma

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

radwa.shamma@gmail.com

City

-

Orcid

-

First Name

Iman

Last Name

Abdelaziz

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

iman.omar@kasralainy.edu.eg

City

Cairo

Orcid

0000-0001-5753-718

Volume

2

Article Issue

1

Related Issue

29646

Issue Date

2022-01-01

Receive Date

2021-12-03

Publish Date

2022-01-01

Page Start

89

Page End

98

Print ISSN

2805-279X

Online ISSN

2682-3985

Article File

CUPSJ_Volume 2_Issue 1_Pages 89-98.pdf

PDF . 5.3MB

Link

https://cupsj.journals.ekb.eg/article_210825.html

Detail API

https://cupsj.journals.ekb.eg/service?article_code=210825

Order

12

Type

Original Research

Type Code

1,229

Publication Type

Journal

Publication Title

Pediatric Sciences Journal

Publication Link

https://cupsj.journals.ekb.eg/

MainTitle

Chronic Hepatic Venous Ischemia Secondary to Venous Outflow Insufficiency Causes Chronic Rejection in Pediatric Liver Transplant Recipients

Details

Type

Article

Created At

22 Jan 2023