Is stenting really necessary during primary angioplasty for portal vein stenosis after pediatric liver transplantation?

To the editor, The paper by Bukova et al.1 that was published on liver transplantation dangerously questions the possibility of effectively treating portal vein stenosis after pediatric liver transplantation without the need for primary stenting. In a retrospective cohort of a total of 470 pediatric liver transplants performed in a single center from 2004 to 2020, they reported very positive outcomes with a mean follow-up of 5.7 years and they concluded that primary stent angioplasty should be considered as first-line treatment for portal vein stenosis after pediatric LT. In our opinion, this data must be considered with caution in pediatric patients who have a much longer life expectancy after liver transplantation. The placement of metal stents in pediatric patients hinders the possibility of future re-transplantation due to the technical challenges of performing new vascular anastomoses on vessels engaged with unremovable metal devices. We believe that Liver Transplantation readers should be aware that there is quite sufficient evidence to claim that simple angioplasty is advisable rather than primary stent angioplasty to treat pediatric posttransplantation portal vein stenosis. Excellent mid-term and long-term outcomes are reported by several studies.2–5 More data will be made available by the international PORTAL registry sponsored by the University of Groningen, involving more than 30 liver transplant centers all over the world. Registry completion and results publication are expected in a few months.