OBJECTIVES:To describe national patterns of management, outcomes, and prognostic factors in infants with biliary atresia (BA) in Italy. METHODS:This retrospective study used data from the Italian BA Registry from January 2012 to December 2021. Overall, 309 infants with BA were identified. Clearance of jaundice (CoJ) was defined as total bilirubin <1.2 mg/dL within 6 months. Univariate and multivariate analyses were used to identify prognostic factors for native liver and patient survival. RESULTS:Kasai portoenterostomy (KPE) was performed in 272 infants (88%) at a median age of 68.5 days (interquartile range 52-83). The CoJ rate after KPE was 39%. Multivariate analysis confirmed that CoJ was significantly associated with younger age and lower total bilirubin at referral (p = 0.0446 and p = 0.0144, respectively), younger age at KPE (p = 0.0345), and postoperative corticosteroid use (p = 0.0036). Multiple logistic regression confirmed the major effect of steroid use: the odds ratio for steroid use was 2.51 (95% confidence interval 1.38-4.58; p = 0.0027), whereas the odds ratio for age at KPE was 0.987 (95% CI: 0.975-0.999; p = 0.0371). Liver transplantation was performed in 212/309 patients, and overall 5-year actuarial patient survival was 97.4%. CONCLUSIONS:This retrospective analysis confirms that age at KPE and postoperative corticosteroid use are key favorable factors for successful CoJ, with steroid use showing the strongest association. The excellent overall patient survival highlights the critical role of management in expert centers, even within a decentralized model.

Introduction: Spontaneous bile duct perforation (SBDP) in infants is an exceedingly rare occurrence, with this being the first such case reported in the literature. Case presentation: A 15-month-old female infant presented with a 5-day history of progressive abdominal distension, constipation, abdominal pain, and poor feeding. Abdominal ultrasonography demonstrated a large intraperitoneal cystic lesion surrounding the left hepatic lobe. Clinical deterioration within 24 hours prompted a computed tomography scan, which confirmed a large cystic collection at the porta hepatis extending into the lesser sac. Emergency laparotomy revealed approximately 1 L of bilious fluid within a contained pseudocyst extending from the porta hepatis to the lesser sac, with bile-stained bowel loops, and identified a perforation of the segment 3 intrahepatic bile duct. Intraoperative cholangiography localized the perforation and demonstrated a mildly dilated but otherwise normal biliary tree without distal obstruction or anatomical anomalies. The perforation was primarily repaired with interrupted sutures and reinforced with an omental patch, with placement of a cholecystostomy tube and abdominal drains. The post-operative course was uneventful, with reintroduction of feeds and removal of drains by day 10, and follow-up ultrasonography confirming resolution of fluid collections. Magnetic resonance cholangiopancreatography at 7 weeks showed mild residual biliary dilatation without obstruction or pancreaticobiliary maljunction. The child remained well at 2.5, 6, 12, and 18 months of follow-up, with normal clinical, biochemical, and radiological findings. Conclusion: Biliary perforation should be included in the differential diagnosis of children who develop abdominal pain and are found to have a perihepatic cystic mass.

Blood-sparing anesthesia and rapid recovery are central in pediatric liver transplantation (PLTx). The aim of this study was to describe the intraoperative anesthetic management adopted by a dedicated team. This is a retrospective study performed at IRCCS-ISMETT, a transplant center specialized in all solid organ transplantation. Main anesthetic strategies were restrictive crystalloid administration, multifactorial assessment for blood-products transfusion, and planned immediate extubation (IE). Pre-, intra-, and postoperative variables were extracted. Logistic regressions were applied to explore variables associated with PRBC transfusion and IE and subsequent multiple analyses on select variables. Ninety-nine consecutive recipients (0–17 years) between January 2018 and July 2023 were reviewed (75

To evaluate the long-term results of transhepatic treatment of portal vein complications (PVCs) after pediatric liver transplantation (PLTx) at a single center. All interventional procedures for PVCs after PLTx performed between 2005 and 2023 were retrospectively analyzed. Clinical signs of portal hypertension and portal vein (PV) flow velocity on Doppler ultrasound were routinely assessed during follow-up. Primary patency, assisted primary patency, and survival rates were evaluated. Out of 275 consecutive PLTs, 26 children (median age 19.8 months, range: 8.5–154.1) underwent 39 endovascular procedures for PVCs. Technical success was achieved in 97

Purpose: Porto-systemic shunting (PSS) in patients with Abernethy malformation (AM) or obstruction of the portal vein (OVP) is often associated with normal liver parenchyma and hepatic function. This association provides an interesting natural model for studying the brain functional connectivity changes secondary to PSS but independently from hepatic (dys)function. Because PSS can be eliminated with appropriate interventions, these particular conditions offer a unique physio-pathological model where the same patient can be studied in both “active PSS” and “absent PSS” conditions (pre- and post-cure analyses). Methods: Four children (<18 years) who were evaluated for Abernethy malformation (n = 2) or portal cavernoma (n = 2) and underwent corrective surgery (living-donor liver transplantation for AM, or Meso-Rex bypass for OPV, respectively) were included in the study. Brain magnetic resonance imaging and resting-state functional magnetic resonance imaging (rest-fMRI) were acquired in all patients before and after the corrective surgery. A functional connectome analysis was performed before (“active PSS” condition) and after (“absent PSS”—physiological condition) the cure of PSS. Results: As a result of the cancelation of PSS, rest-fMRI connectomics revealed a statistically significant (p < 0.05 family-wise error) improvement in global brain functional connectivity in both groups following each surgical procedure. Conclusions: In this clinical model of isolated PSS (with absence of hepatic dysfunction), brain functional connectivity was altered even in young patients and in the absence of hyperammonemia; moreover, specific interventions to cancel out PSS consequently significantly improved brain functional connectivity.

We thank Jean de Ville de Goyet 1 de Ville de Goyet J. Tailoring allocation policies and improving access to pediatric liver transplantation in Italy: outframing and concluding: Comment on: Tailoring allocation policies and improving access to pediatric liver transplantation over a 16-year period. Spada M, et al. J Hepatol. 2024 Feb 12; S0168-8278 (0)00126 Google Scholar for his interest in our work recently published in the Journal of Hepatology2 Spada M. Angelico R. Trapani S. Masiero L. Puoti F. Colledan M. Cintorino D. Romagnoli R. Cillo U. Cardillo M. Italian College of Liver Transplant ProgramTailoring allocation policies and improving access to paediatric liver transplantation over a 16-year period. J Hepatol. 2024 Mar; 80: 505-514 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar . The objective of our study was to define the outcome of patients <18 years old listed in Italy for liver transplantation (LT) from deceased-donor in an intention-to-treat (ITT) survival analysis and to identify the factors that influence the possibility of being transplanted and leaving the waiting list (WL) due to death or clinical deterioration. The results of our study showed that children inscribed in the Italian deceased-donor LT (DDLT) WL are transplanted within 44 days (IQR: 15–120) in case of status 3 (non-urgent transplantation) and within 2 days (IQR: 1–5) for status 1 (urgent transplantation). Also, the continuous adapting of liver allocation policies for pediatric LT led to achieve satisfactory outcomes, with ITT survival rates of 90.5% at 1 year and 87.5% at 5 years remaining stable across Eras. Tailoring allocation policies and improving access to pediatric liver transplantation in Italy: outframing and concludingJournal of HepatologyPreviewno conflict of interest – academic opinion work. Full-Text PDF Tailoring allocation policies and improving access to paediatric liver transplantation over a 16-year periodJournal of HepatologyVol. 80Issue 3PreviewMortality on the paediatric liver transplantation (pLT) waiting list (WL) is still an issue. We analysed the Italian pLT WL to evaluate the intention-to-treat (ITT) success rate and to identify factors influencing success. Full-Text PDF

[This corrects the article DOI: 10.1016/j.jhepr.2023.100933.].

Background Liver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of intraoperative and postoperative complications. So far, only limited data regarding the best radiological approach to monitor children during liver transplantation is available. Objective To harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra- and postoperative phase. This paper reports the responses related to intraoperative imaging. Materials and methods An online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey. Results Intraoperative ultrasound (US) is used by all sites to assess the quality of the vascular anastomosis in order to ensure optimal perfusion of the liver transplant. Vessel depiction is commonly achieved using color Doppler (95.3%). Additional US-based techniques are employed by fewer centers (power angio mode, 28.6%; B-flow, 19%; contrast-enhanced US, 14.3%). Most centers prefer a collaborative approach, with surgeons responsible for probe handling, while radiologists operate the US machine (47.6%). Less commonly, the intraoperative US is performed by the surgeon alone (28.6%) or by the radiologist alone (23.8%). Timing of US, imaging frequency, and documentation practices vary among centers. Conclusion Intraoperative US is consistently utilized across all sites during pediatric liver transplantation. However, considerable variations were observed in terms of the US setup, technique preferences, timing of controls, and documentation practices. These differences provide valuable insights for future optimization and harmonization studies.

BACKGROUND:Split and living donor liver transplantations are both key surgical strategies for development of pediatric liver transplant programs. Often, however, teams tend to prioritize only one preferentially. METHODS:In the context of a very active national split liver graft allocation program (Italy), retrospective study of 226 consecutive pediatric first isolated liver transplants performed by a single team using organs from both deceased and living donors. Clinical characterisitics and outcome were compared. RESULTS:In the context of a steadily slowly decreasing split graft offer, living donation activity steadily increased. Deceased and living donation accounted for 52.6% and 47.4% of transplantations, respectively. Both strategies were equally used for transplanting patients up to 30 kg of weight, while deceased donors were predominantly used for older recipients. Technical variants represented 86% of all transplants, with 183 conisting of left lateral segment grafts (76 split liver grafts and 107 left grafts from living donors). Outcome of both surgical strategies was similar, with excellent outcomes at early, mid-, and long-term. CONCLUSIONS:Splitting livers of deceased donors and using living donation were complementary and non-competitive strategies for developping pediatric liver transplant activity. Implementing both activities in parallell allowed to maintain stable the number of annual transplant in Italy and allowed to reach superior outcomes. This analysis provides evidence that living donation plays a role in Italy despite an existing very active "mandatory-split" national policy.

The authors received NO financial support to produce this manuscript. Improving outcomes of in situ split liver transplantation in Italy over the last 25 yearsJournal of HepatologyVol. 79Issue 6PreviewSplit liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time. Full-Text PDF Outcome of in-situ split liver transplantation in Italy over the last 25 years : an alternative analysis and personal viewJournal of HepatologyPreviewIn this edition, Lauterio et al.1 presented the results of a retrospective analysis of “25 years of split liver transplantation (LT) in Italy”. Right split grafts(RSG) outcome seemed to have improved significantly, while left split grafts (LSG) survival has not improved significantly in 25 years - a concerning finding Full-Text PDF

Background Liver transplantation is the state-of-the-art curative treatment in end-stage liver disease. Imaging is a key element for successful organ-transplantation to assist surgical planning. So far, only limited data regarding the best radiological approach to prepare children for liver transplantation is available. Objectives In an attempt to harmonize imaging surrounding pediatric liver transplantation, the European Society of Pediatric Radiology (ESPR) Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra-, and postoperative phase. This paper reports the responses on preoperative imaging. Material and methods An online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted and 22 institutions from 11 countries returned the survey. From 2018 to 2020, the participating centers collectively conducted 1,524 transplantations, with a median of 20 transplantations per center per annum (range, 8–60). Results Most sites (64%) consider ultrasound their preferred modality to define anatomy and to plan surgery in children before liver transplantation, and additional cross-sectional imaging is only used to answer specific questions (computed tomography [CT], 90.9%; magnetic resonance imaging [MRI], 54.5%). One-third of centers (31.8%) rely primarily on CT for pre-transplant evaluation. Imaging protocols differed substantially regarding applied CT scan ranges, number of contrast phases (range 1–4 phases), and applied MRI techniques. Conclusion Diagnostic imaging is generally used in the work-up of children before liver transplantation. Substantial differences were noted regarding choice of modalities and protocols. We have identified starting points for future optimization and harmonization of the imaging approach to multicenter studies.

Pediatric TransplantationVolume 28, Issue 3 e14748 EDITORIAL Small-for-size liver graft syndrome. Not everything is what it seems to be: Even salt looks like sugar Jean de Ville de Goyet, Corresponding Author Jean de Ville de Goyet [email protected] orcid.org/0000-0001-7681-6178 Pediatric Surgery Unit, Department of Pediatrics, IRCCS-ISMETT (Institute for scientific-based care and research—Mediterranean Institute for Transplantation and Advanced Specialized Therapies)—UPMC (University of Pittsburgh Medical School), Palermo, Italy Correspondence Jean de Ville de Goyet, IRCCS-ISMETT (Institute for scientific-based care and research—Mediterranean Institute for Transplantation and Advanced Specialized Therapies)—UPMC (University of Pittsburgh Medical School), 90127 Palermo, Italy. Email: [email protected]Search for more papers by this author Jean de Ville de Goyet, Corresponding Author Jean de Ville de Goyet [email protected] orcid.org/0000-0001-7681-6178 Pediatric Surgery Unit, Department of Pediatrics, IRCCS-ISMETT (Institute for scientific-based care and research—Mediterranean Institute for Transplantation and Advanced Specialized Therapies)—UPMC (University of Pittsburgh Medical School), Palermo, Italy Correspondence Jean de Ville de Goyet, IRCCS-ISMETT (Institute for scientific-based care and research—Mediterranean Institute for Transplantation and Advanced Specialized Therapies)—UPMC (University of Pittsburgh Medical School), 90127 Palermo, Italy. Email: [email protected]Search for more papers by this author First published: 12 April 2024 https://doi.org/10.1111/petr.14748Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. CONFLICT OF INTEREST STATEMENT No conflict of interest. Open Research DATA AVAILABILITY STATEMENT For this Editorial, no data were used; no data are thus available. REFERENCES 1Adam R, Castaing D, Bismuth H. Transplantation of small donor livers in adult recipients. Transplant Proc. 1993; 25: 1105-1106. CASPubMedWeb of Science®Google Scholar 2Azoulay D, Castaing D, Adam R, et al. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann Surg. 2001; 233: 565-574. 10.1097/00000658-200104000-00013 CASPubMedWeb of Science®Google Scholar 3Goldaracena N, Echeverri J, Selzner M. Small-for-size syndrome in live donor liver transplantation-pathways of injury and therapeutic strategies. Clin Transpl. 2017; 31: Epub 2017 Jan 11. 10.1111/ctr.12885 Web of Science®Google Scholar 4Masuda Y, Yoshizawa K, Ohno Y, Mita A, Shimizu A, Soejima Y. Small-for-size syndrome in liver transplantation: definition, pathophysiology and management. Hepatobiliary Pancreat Dis Int. 2020; 19: 334-341. 10.1016/j.hbpd.2020.06.015 CASPubMedWeb of Science®Google Scholar 5Sainz-Barriga M, Scudeller L, Costa MG, de Hemptinne B, Troisi RI. Lack of a correlation between portal vein flow and pressure: toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation. Liver Transpl. 2011; 17: 836-848. 10.1002/lt.22295 PubMedWeb of Science®Google Scholar 6Rammohan A, Rela M, Kim DS, et al. Does modification of portal pressure and flow enhance recovery of the recipient after living donor liver transplantation? A systematic review of literature and expert panel recommendations. Clin Transpl. 2022; 36:e14657. 10.1111/ctr.14657 PubMedWeb of Science®Google Scholar 7Kwon YK, Haytham M, Valentino P, Healey P. Small-for-size syndrome in a 9.7kg pediatric recipient with a whole liver graft. Pediatr Transplant. 2024; 28:e14716. 10.1111/petr.14716 PubMedWeb of Science®Google Scholar 8Yang X, Wang H, Dong B, et al. Standard liver volume-predicting formulae derived from Normal liver volume in children under 18 years of age. Front Pediatr. 2021; 9:629645. 10.3389/fped.2021.629645 PubMedWeb of Science®Google Scholar 9Peters M, Sturm E, Hartleif S, et al. Whole liver transplantation in children under 10 kg: how to minimize the high risks of a still challenging procedure. Pediatr Transplant. 2022; 26:e14222. 10.1111/petr.14222 PubMedWeb of Science®Google Scholar 10de Ville de Goyet J, di Francesco F, Sottani V, et al. Splitting livers: trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes. Pediatr Transplant 2015; 19: 517–526. 10.1111/petr.12534 PubMedWeb of Science®Google Scholar Volume28, Issue3May 2024e14748 ReferencesRelatedInformation

Background Liver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of postoperative complications. So far, limited data is available regarding the best radiologic approach to monitor children after liver transplantation. Objective To harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra-, and postoperative phases. This paper reports the responses related to postoperative imaging. Materials and methods An online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey. Results All sites commence ultrasound (US) monitoring within 24 h after liver transplantation. Monitoring frequency varies across sites, ranging from every 8 h to 72 h in early, and from daily to sporadic use in late postoperative phases. Predefined US protocols are used by 73% of sites. This commonly includes gray scale, color Doppler, and quantitative flow assessment. Alternative flow imaging techniques, contrast-enhanced US, and elastography are applied at 31.8%, 18.2%, and 63.6% of sites, respectively. Computed tomography is performed at 86.4% of sites when clarification is needed. Magnetic resonance imaging is used for selected cases at 36.4% of sites, mainly for assessment of biliary abnormalities or when blood tests are abnormal. Conclusion Diagnostic imaging is extensively used for postoperative surveillance of children after liver transplantation. While US is generally prioritized, substantial differences were noted in US protocol, timing, and monitoring frequency. The study highlights potential areas for future optimization and standardization of imaging, essential for conducting multicenter studies.

Transplant Infectious DiseaseEarly View e14254 CLINICAL CORRESPONDENCE Hepatic granulomas in a pediatric liver transplant recipient Giovanni Mulé, Corresponding Author Giovanni Mulé [email protected] orcid.org/0000-0003-1156-2204 Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione—Istituto di Ricovero e Cura a Carattere Scientifico), Palermo, Italy Correspondence Giovanni Mulé, Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione—Istituto di Ricovero e Cura a Carattere Scientifico), 90133 Palermo, Italy. Email: [email protected]Search for more papers by this authorJean de Ville de Goyet, Jean de Ville de Goyet Department of Pediatrics, Surgery and Transplantation Pediatric Unit, ISMETT-IRCCS (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione—Istituto di Ricovero e Cura a Carattere Scientifico), Palermo, ItalySearch for more papers by this authorAlessandra Mularoni, Alessandra Mularoni orcid.org/0000-0001-8612-5581 Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione—Istituto di Ricovero e Cura a Carattere Scientifico), Palermo, ItalySearch for more papers by this author Giovanni Mulé, Corresponding Author Giovanni Mulé [email protected] orcid.org/0000-0003-1156-2204 Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione—Istituto di Ricovero e Cura a Carattere Scientifico), Palermo, Italy Correspondence Giovanni Mulé, Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione—Istituto di Ricovero e Cura a Carattere Scientifico), 90133 Palermo, Italy. Email: [email protected]Search for more papers by this authorJean de Ville de Goyet, Jean de Ville de Goyet Department of Pediatrics, Surgery and Transplantation Pediatric Unit, ISMETT-IRCCS (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione—Istituto di Ricovero e Cura a Carattere Scientifico), Palermo, ItalySearch for more papers by this authorAlessandra Mularoni, Alessandra Mularoni orcid.org/0000-0001-8612-5581 Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione—Istituto di Ricovero e Cura a Carattere Scientifico), Palermo, ItalySearch for more papers by this author First published: 13 February 2024 https://doi.org/10.1111/tid.14254Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. CONFLICT OF INTEREST STATEMENT The authors of this manuscript have no conflicts of interest to disclose. Open Research DATA AVAILABILITY STATEMENT The data presented in this study will be available from the corresponding author on reasonable request. REFERENCES 1Psarros G, Riddell J, Gandhi T, Kauffman CA, Cinti SK. Bartonella henselae infections in solid organ transplant recipients: report of 5 cases and review of the literature. Medicine. 2012; 91(2): 111-121. doi:10.1097/MD.0b013e31824dc07a 10.1097/MD.0b013e31824dc07a PubMedWeb of Science®Google Scholar 2Steed D, Collins J, Farris AB, et al. Haemophagocytic lymphohistiocytosis associated with Bartonella peliosis hepatis following kidney transplantation in a patient with HIV. Lancet Infect Dis. 2022; 22(10): e303-e309. doi:10.1016/S1473-3099(22)00276-6 10.1016/S1473-3099(22)00276-6 PubMedGoogle Scholar 3Bos F, Chauveau B, Ruel J, et al. Serious and atypical presentations of Bartonella henselae infection in kidney transplant recipients. Open Forum Infect Dis. 2022; 9(3). doi:10.1093/ofid/ofac059 10.1093/ofid/ofac059 PubMedGoogle Scholar 4Vissotto De Paiva Diniz PP, Maggi RG, Schwartz DS, et al. Canine bartonellosis: serological and molecular prevalence in Brazil and evidence of co-infection with Bartonella henselae and Bartonella vinsonii subsp. berkhoffii. Vet Res. 2007; 38(5): 697-710. doi:10.1051/vetres:2007023 10.1051/vetres:2007023 PubMedGoogle Scholar 5Rostad CA, Mcelroy AK, Hilinski JA, et al. Bartonella henselae-mediated disease in solid organ transplant recipients: two pediatric cases and a literature review. Transplant Infectious Disease. 2012; 14(5). doi:10.1111/j.1399-3062.2012.00774.x 10.1111/j.1399-3062.2012.00774.x PubMedGoogle Scholar 6Lopez SMC, Davis A, Zinn M, Feingold B, Green M, Michaels MG. Bartonella henselae infection in the pediatric solid organ transplant recipient. Pediatr Transplant. 2021; 25(5). doi:10.1111/PETR.13823 10.1111/petr.13823 PubMedGoogle Scholar 7Mosepele M, Mazo D, Cohn J. Bartonella infection in immunocompromised hosts: immunology of vascular infection and vasoproliferation. Clin Dev Immunol. 2012; 2012. doi:10.1155/2012/612809 10.1155/2012/612809 PubMedGoogle Scholar 8Kaiser PO, Riess T, O'rourke F, Linke D, Kempf VAJ. Bartonella spp.: throwing light on uncommon human infections. Int J Med Microbiol. 2011; 301(1): 7-15. doi:10.1016/j.ijmm.2010.06.004 10.1016/j.ijmm.2010.06.004 CASPubMedWeb of Science®Google Scholar 9Lee RA, Ray M, Kasuga DT, Kumar V, Witherspoon CD, Baddley JW. Ocular bartonellosis in transplant recipients: two case reports and review of the literature. Transplant Infectious Disease. 2015; 17(5): 723-727. doi:10.1111/tid.12418 10.1111/tid.12418 CASPubMedWeb of Science®Google Scholar 10Pischel L, Radcliffe C, Vilchez GA, Charifa A, Zhang Xu-C, Grant M. Bartonellosis in transplant recipients: a retrospective single center experience. World J Transplant. 2021; 11(6): 244-253. doi:10.5500/WJT.V11.I6.244 10.5500/wjt.v11.i6.244 PubMedGoogle Scholar Early ViewOnline Version of Record before inclusion in an issuee14254 ReferencesRelatedInformation

Congenital portosystemic shunts are often associated with systemic complications, the most challenging of which are liver nodules, pulmonary hypertension, endocrine abnormalities, and neurocognitive dysfunction. In the present paper, we offer expert clinical guidance on the management of liver nodules, pulmonary hypertension, and endocrine abnormalities, and we make recommendations regarding shunt closure and follow-up.