To analyze the possible risk factors which were related to portal vein stenosis (PVS) after pediatric liver transplantation, and to explore the clinical efficacy of different therapeutic method.

The clinical data of 396 pediatric liver transplantation recipients (age ≤14 years old) who got transplantation at the liver transplantation center of Beijing friendship hospital from June 2013 to December 2017 were retrospectively analyzed. All the recipients were followed up until June 2018, during which 26 recipients (6.6%) were diagnosed with PVS. For pediatric recipients who were suspected of PVS by ultrasound, portal vein angiography was used to make a definite diagnosis. Doppler ultrasound was used to monitor the caliber and velocity of the portal vein after transplantation. PVS was treated with follow-up and oral anticoagulant therapy, balloon angioplasty, portal vein stent placement, or Meso-Rex bypass surgery. Change of liver function was monitored. Portal-related graft injury was assessed. Symptoms or signs associated with portal hypertension was observed.

The median time of diagnosis of postoperative PVS in 26 pediatric recipients was 9.5 months (1.3~50.0 months), among which 26.9% (7/26) occurred within 3 months, and 73.1% (19/26) occurred after 3 months. Forty-seven person-time including medical intervention, balloon dilation, stent placement or Meso-Rex surgery were carried out, and no recipient died from PVS. Two recipients were followed up dynamically, during which oral anticoagulant drugs were taken. Twenty-three recipients got portal vein balloon dilatation, 1 recipient got a portal balloon dilation and stent placement because of portal vein lengthy, 10 recipients accepted second portal vein balloon angioplasty due to the failure of the balloon angioplasty, 7 recipients accepted portal vein stent placement due to the failure of the second balloon angioplasty, 2 recipients occured with portal vein stenosis again after portal vein stent placement, and then they received Meso-Rex surgery. For 1 recipient who received oral anticoagulant therapy during follow-up, the result of ultrasound examination suggested that the portal vein velocity was too fast, and no PVS recurrence was found in the remaining patients.

Doppler ultrasound is an effective method to monitor the portal vein and detect PVS early in pediatric liver transplantation .In the case of PVS, children with mild clinical symptoms could be followed up dynamically, during which oral anticoagulant drugs should be taken. Portal vein balloon dilatation and portal vein stent implacement are the first choice for moderate and severe recipients. Meso-Rex bypass surgery is an optional procedure for recurrence after portal stent implacement or portal vein occlusion.