Balloon-occluded retrograde transvenous obliteration for a portosystemic shunt after pediatric living-donor liver transplantation

Portosystemic shunts may cause steal phenomenon after liver transplantation, which can lead to graft loss without proper management. Portal vein stenosis is one of the causes for the occurrence of portosystemic shunts after liver transplantation. Recently, new interventional radiologic techniques have been developed in the field of liver transplantation. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a novel interventional technique for gastric varices and portosystemic shunts and also is effective for increasing portal vein flow. We herein report a pediatric case of portal vein stenosis with a large shunt successfully treated with a combination of balloon dilatation and B-RTO. If enlarged collateral vessels cause steal phenomenon, then B-RTO should be considered as an additional therapy.