Citations 1
Portal Vein Thrombosis in Pediatric Liver Transplantation With Technical Variant Grafts: An International Multicenter Analysis of Risk and Prognostic Factors
Raptis, Dimitri A., Gunasekaran, Vasanthakumar , Rammohan, Ashwin, Sakamoto, Seisuke, Uchida, Hajime, Beekum, Cornelius J. van, Krendl, F. J., Chen, Itsuko Chih-Yi, Domenick, Bryanna , Kow, Alfred, Soejima, Yuji, Furuya, Katryn N. , Mazariegos, George V., Dunn, Stephen, Olthoff, Kim, Rand, Elizabeth B. , Chen, C L, Balci, Deniz, Nadalin, Silvio, Schneeberger, Stefan, Sudan, Debra L., Schmelzle, Moritz, Herden, Uta , Fischer, L, Sayed, Blayne A., Ng, Vicky L, Kasahara, Mureo, Rela, Mohamed, Broering, Dieter C., Xia, Qiang, Clavien, P A, Li, Zhihao, Sudan, Debra L. , Li, Zhihao , Sayed, Blayne A , Sudan, Debra L , Li, Zhihao , Wang, Kaihang , Madadi‐Sanjani, Omid , Y, Liu , Raptis, Dimitri , Rammohan, Ashwin , Sakamoto, Seisuko , Uchida, Hajime , Kaliciński, Piotr , Goldaracena, Nicolás , Beekum, Cornelius J. van , Krendl, Felix Julius , Chen, Itsuko Chih-Yi, Kow, Alfred Wei Chieh , Soejima, Yuji , Mazariegos, George , Mali, Vidyadhar Padmakar , Leipnitz, Ian , Balci, Deniz , Kirimker, Elvan Onur , Nadalin, Silvio , Schneeberger, Stefan , Schmelzle, Moritz , Sayed, Blayne A. , Kowalewski, Grzegorz , Kasahara, Mureo , Rela, Mohamed , Bröering, Dieter C. , Xia, Qiang
Transplantation | June 9, 2026 | Volume: 110 | Issue: 8 | Pages: e1695-e1704
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.