Efficacy and patency of primary stenting for hepatic venous outflow obstruction after living donor liver transplantation

Abstract

Percutaneous primary hepatic vein stent replacement is an effective treatment for HVOO after LDLT.

Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience

“…According to previous reports, most post-LDLT complications are caused by limited graft volume (graft-to-recipient weight ratio of < 0.8), bile duct variations (eg, multiple bile ducts and narrow bile ducts), complex venous drainage pattern (eg, V5, V8, right inferior hepatic veins and middle hepatic vein), short and narrow venous structures, abnormal portal vein patterns (duplex or triplex portal vein), and hepatic artery variations (eg, multiple arteries, short artery, and narrow artery). 4 Hepatic venous outflow obstruction is a rare, albeit serious, vascular complication of liver transplant, which may lead to graft loss or death in the absence of appropriate treatment. 2,4,6 Promptly recognizing and addressing this condition are vital steps for graft function.…”

“…4 Hepatic venous outflow obstruction is a rare, albeit serious, vascular complication of liver transplant, which may lead to graft loss or death in the absence of appropriate treatment. 2,4,6 Promptly recognizing and addressing this condition are vital steps for graft function. 3 Early-onset HVOO can result from a number of factors, such as a tense suture line, bending of a redundant hepatic vein, mismatch between the size of recipient and graft, low recipientto-donor body mass index ratio, compression of the IVC by a large graft, and thrombosis.…”

“…3 Early-onset HVOO can result from a number of factors, such as a tense suture line, bending of a redundant hepatic vein, mismatch between the size of recipient and graft, low recipientto-donor body mass index ratio, compression of the IVC by a large graft, and thrombosis. 2,4,7 In contrast, the cause of late-onset HVOO includes intimal hyperplasia, fibrosis development secondary to inflammation (ie, abscesses or bile leaks), twisting of an anastomosis, external compression due to graft growth, and anastomosis strictures secondary to fibrotic changes in the dissection field. 2,4 After a first description of the standard end-toend cavocaval anastomosis technique for DDLT, researchers were stimulated to develop improved anastomosis techniques, such as the piggyback and the modified piggyback to minimize the rate of HVOO.…”

“…2,4,7 In contrast, the cause of late-onset HVOO includes intimal hyperplasia, fibrosis development secondary to inflammation (ie, abscesses or bile leaks), twisting of an anastomosis, external compression due to graft growth, and anastomosis strictures secondary to fibrotic changes in the dissection field. 2,4 After a first description of the standard end-toend cavocaval anastomosis technique for DDLT, researchers were stimulated to develop improved anastomosis techniques, such as the piggyback and the modified piggyback to minimize the rate of HVOO. As a result, rates of venovenous bypassrelated complications dropped remarkably and the incidence of posttransplant HVOO has been reduced to acceptable levels.…”

“…[1][2][3][4] Although deceased-donor liver transplant (DDLT) constitutes a large percentage of liver transplant procedures performed in Western countries, most liver transplant procedures performed in many of the Asian countries (including Turkey) use organs obtained from living donors (that is, living-donor liver transplant; LDLT). 1 The surgical techniques of DDLT and LDLT differ, as do the posttransplant liver functions resulting from each.…”