Portal Vein Thrombosis in Pediatric Liver Transplantation With Technical Variant Grafts: An International Multicenter Analysis of Risk and Prognostic Factors

BACKGROUND: The adoption of technical variant grafts has expanded the donor pool for pediatric liver transplantation, but it also poses a risk of portal vein thrombosis (PVT). This study evaluated risk and prognostic factors of PVT in children undergoing liver transplantation with technical variant grafts. 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.

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Journal
Transplantation
Published
2026-06-09
DOI
https://doi.org/10.1097/tp.0000000000005777
Primary Topic
Organ Transplantation Techniques and Outcomes
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article
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article

Portal Vein Thrombosis in Pediatric Liver Transplantation With Technical Variant Grafts: An International Multicenter Analysis of Risk and Prognostic Factors

Elvan Onur Kırımker, V. W. K. Ng, L Fischer, Uta Herden et al.
Transplantation
Organ Transplantation Techniques and Outcomes
article

Portal Vein Thrombosis in Pediatric Liver Transplantation With Technical Variant Grafts: An International Multicenter Analysis of Risk and Prognostic Factors

Elvan Onur Kırımker, V. W. K. Ng, L Fischer, Uta Herden, Nicolás Goldaracena, Ian Leipnitz, Vidyadhar Padmakar Mali, Grzegorz Kowalewski, Vasanthakumar Gunasekaran, C L Chen, Katryn N. Furuya, Kaihang Wang, Omid Madadi‐Sanjani, Elizabeth B. Rand, Bryanna Domenick, Liu Y, Dimitri A. Raptis, F. J. Krendl, Blayne A. Sayed, Kim Olthoff, Alfred Kow, Piotr Kaliciński, George V. Mazariegos, P A Clavien, Deniz Balci, Debra L. Sudan, Stephen Dunn, Moritz Schmelzle, Mohamed Rela, Stefan Schneeberger, Zhihao Li, Itsuko Chih-Yi Chen, Mureo Kasahara, Seisuke Sakamoto, Silvio Nadalin, Dieter C. Broering, Yuji Soejima, Hajime Uchida, Ashwin Rammohan, Qiang Xia, Cornelius J. van Beekum
article en

Abstract

BACKGROUND: The adoption of technical variant grafts has expanded the donor pool for pediatric liver transplantation, but it also poses a risk of portal vein thrombosis (PVT). This study evaluated risk and prognostic factors of PVT in children undergoing liver transplantation with technical variant grafts. 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.

Transplantation
Bahçeşehir University (TR), University Health Network (CA), Alfred I. duPont Hospital for Children (US), Children's Hospital of Philadelphia (US), University of Wisconsin–Madison (US), Shinshu University (JP), Innsbruck Medical University (AT), Ankara University (TR), University of Auckland (NZ), Universität Hamburg (DE), National University of Singapore (SG), Duke University (US), Shanghai Jiao Tong University (CN), Universität Innsbruck (AT), University of Zurich (CH), Renji Hospital (CN), Tamil Nadu Dr. M.G.R. Medical University (IN), King Faisal Specialist Hospital & Research Centre (SA), Hospital for Sick Children (CA), Medizinische Hochschule Hannover (DE), ETH Zurich (CH), Kaohsiung Chang Gung Memorial Hospital (TW), University Medical Center Hamburg-Eppendorf (DE), Children's Memorial Health Institute (PL), Mayo Clinic in Arizona (US), Duke Medical Center (US), Children's Hospital of Pittsburgh (US), National Center For Child Health and Development (JP), National University Hospital (SG), Wisconsin Division of Public Health (US), University of Pennsylvania (US), University of Tübingen (DE)
Good health and well-being
Openalex Percentile: Top 6%
Organ Transplantation Techniques and Outcomes
DOIOpen Access PDFOpenAlex
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