Management of Acute Portal Vein Thrombosis With Serial Mechanical Thrombectomy and tPA in a Pediatric Liver Transplant Recipient: A Case Report |
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| Institution: | 1. McGovern Medical School, University of Texas Health Science Center, Houston, Texas;2. Texas Children''s Hospital Department of Radiology, Interventional Radiology, Houston, Texas;3. Texas Children''s Hospital Department of Critical Care, and Liver Intensive Care Unit, Houston, Texas;4. Texas Children''s Hospital, Liver Transplantation Service, Houston, Texas;5. Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Houston, Texas;1. Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois;2. Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois;3. Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;4. Department of Pathology, University of Illinois at Chicago, Chicago, Illinois;1. Department of General Surgery, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey;2. Department of Histology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey;3. Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey;4. Department of Biochemistry, Faculty of Pharmacy, Ibrahim Cecen University, Agri, Turkey;1. Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India;2. Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India;3. Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal;4. Department of Nephrology, Osmania General Hospital, Hyderabad, India;5. Department of Nephrology, Nizam''s Institute of Medical Sciences, Panjagutta, Hyderabad, India;6. Department of Nephrology, Institute of Post-Graduate Medical Education & Research, Kolkata, India;7. Department of Nephrology, Manipal Hospital, Bangalore, India;8. Department of Nephrology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India;9. Department of Nephrology, Jaslok Hospitals, Mumbai, India;10. Departmentt of Nephrology, Centre Yashoda Hospitals, Secunderabad, India;11. Department of Nephrology and Renal Transplantation, Indira Gandhi Institute of Medical Science, Patna, India;12. Lakeshore Hospital, Kochi, Kerala, India;13. B. J. Medical Hospital, Civil Hospital, Ahmedabad, Gujarat, India;14. Department of Gynecology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India;1. Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences/Nagasaki University Hospital, Nagasaki, Japan;2. Atopy (Allergy) Research Center, Juntendo University, Tokyo, Japan;3. Department of Gastroenterological Surgery I, Hokkaido University, Hokkaido. Japan;4. Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan;5. Research Institute, St. Mary''s Hospital, Fokuoka, Japan;1. Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar;2. Weill Cornell Medical College, Doha, Qatar;3. Division of Transplantation Surgery, Department of Surgery, Hamad Medical Corporation, Doha, Qatar;1. Transplant Surgery Section, Surgery Department, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia;2. Department of Nephrology, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia;3. Department of Anesthesiology, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia |
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| Abstract: | BackgroundAcute portal vein thrombosis is a major cause of fulminant allograft failure in pediatric liver transplantation. Timely intervention is critical to save the graft and patient. Serial interventional radiologic management of this condition is scarcely reported in the literature.Case SummaryA recently transplanted 17-year-old male presented to the emergency department with abdominal pain. Rising liver enzymes prompted discovery of a diffuse portal thrombus, which precipitated fulminant liver failure. The adolescent developed respiratory failure, vasodilatory shock, acute kidney injury, and hepatic encephalopathy, complicating treatment. Multiple interventions attempted to clear the thrombus, including interventional radiologic and medical therapies. Uniquely, a continuous infusion catheter was placed at the thrombosis, delivering local tissue plasminogen activator during a 5-day period. Upon thrombus clearance, the patient made a full recovery with no complications during 12 months of follow-up.ConclusionsWhen used as a component of multidisciplinary management, continuous locally directed tissue plasminogen activator may be a useful tool for clearance of persistent portal vein thrombosis. |
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