Pediatric Portal Hypertension Center

When a child is diagnosed with portal hypertension, families often encounter considerable uncertainty regarding diagnosis, prognosis, and treatment options. At the Miami Transplant Institute, our Pediatric Portal Hypertension Center provides comprehensive, multidisciplinary care for children with both liver-related and non-cirrhotic causes of portal hypertension. Our program integrates expert evaluation, advanced diagnostics, individualized treatment planning, and longitudinal follow-up.

Our objective is to preserve hepatic function, prevent complications, improve quality of life, and ensure that each child receives the most appropriate therapy, ranging from medical management to advanced interventions and, when indicated, liver transplantation.

Portal hypertension is defined by elevated pressure within the portal venous system, which transports blood from the intestines to the liver. In pediatric patients, this condition may arise from chronic liver disease, congenital abnormalities, portal vein thrombosis, biliary atresia, vascular disorders, or other rare etiologies.

Without specialized management, portal hypertension may result in clinically significant complications, including variceal formation, gastrointestinal hemorrhage, splenomegaly, low cell counts, ascites, growth impairment, and hepatic encephalopathy.

Children with portal hypertension frequently require evaluation and treatment by multiple subspecialists. Rather than coordinating care across separate settings, our multidisciplinary team collaborates to develop a unified, patient-specific management plan.

Our team includes pediatric hepatologists, transplant surgeons, pediatric gastroenterologists, advanced endoscopists, interventional radiologists, diagnostic imaging specialists, hematologists, nutrition experts, psychologists, transplant coordinators, social workers, and specialized nursing staff.

Together, we assess each patient’s anatomy, underlying diagnosis, and disease severity to determine the most appropriate therapeutic strategy.

Our center evaluates infants, children, and adolescents with:

• Portal vein thrombosis
• Cavernous transformation of the portal vein
• Extrahepatic portal vein obstruction
• Chronic liver disease and cirrhosis
• Biliary atresia
• Congenital hepatic fibrosis
• Autoimmune liver disease
• Metabolic liver disease
• Budd-Chiari syndrome
• Recurrent gastrointestinal bleeding from varices
• Enlarged spleen with low platelet counts
• Ascites
• Unexplained portal hypertension

We also provide second opinions for children with complex portal hypertension or those being considered for advanced interventions.

Accurate diagnosis is essential, as treatment selection depends on the underlying cause.

Our evaluation may include:

• Advanced Doppler ultrasound
• High-resolution cross-sectional imaging (MRI or CT)
• Upper endoscopy
• Laboratory evaluation
• Hemodynamic assessment when indicated
• Hypercoagulable evaluation for children with portal vein thrombosis
• Multidisciplinary review of imaging and clinical findings

Each child receives an individualized diagnostic plan rather than a uniform approach.

Treatment is determined by the etiology of portal hypertension and the complications present.
Our center offers:

• Medical management
• Surveillance and treatment of esophageal and gastric varices
• Advanced pediatric endoscopic therapies
• Interventional radiology procedures
• Surgical management of portal hypertension
• Portal vein reconstruction when anatomically appropriate
• Selective portosystemic shunt procedures
• Comprehensive liver transplant evaluation for children with advanced liver disease

Whenever possible, we prioritize therapies that preserve the child’s native liver while preventing long-term complications.

Every child benefits from coordinated multidisciplinary care.

Complex cases are reviewed collaboratively by pediatric hepatology, transplant surgery, radiology, gastroenterology, hematology, nutrition, psychology, and other specialists as needed. This collaborative model enables families to receive comprehensive recommendations without navigating multiple disconnected opinions.

No.

Many children with portal hypertension do not require liver transplantation. Our first priority is to identify the underlying cause and determine whether medical therapy, endoscopic treatment, interventional procedures, or reconstructive surgery can effectively manage the condition.

If liver transplantation becomes the most appropriate option, our pediatric liver transplant program provides seamless evaluation and continuity of care from diagnosis through long-term follow-up.

Our Pediatric Portal Hypertension Center integrates advanced expertise in pediatric liver disease, complex portal venous disorders, minimally invasive therapies, reconstructive surgery, and pediatric liver transplantation within a single coordinated program.

By bringing together specialists across disciplines, we are able to deliver individualized treatment plans, reduce fragmentation of care, and provide access to the full spectrum of contemporary therapies for portal hypertension.

Whether your child requires ongoing monitoring, treatment of complications, advanced surgical reconstruction, or liver transplantation, our team is committed to providing compassionate, evidence-based care at every stage of the journey.