Endovascular Treatment of Hepatic Venous Outflow Obstruction after Living-donor Liver Transplantation

Ko, Gi Young; Sung, Kyu Bo; Yoon, Hyun Ki; Kim, Jeong-Ho; Song, Ho Young; Seo, Tae Seok; Lee, Sung Gyu

doi:10.1016/s1051-0443(07)61652-2

Cited by 108 publications

(106 citation statements)

References 19 publications

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“…13 The selection of the stent size for each case and careful stent deployment are important to prevent these complications. 26 However, the current results clearly show that the outcomes of cases with stent placement are not satisfactory, and stent placement is often technically demanding.…”

Section: Discussionmentioning

confidence: 81%

“…There have been several studies focused on stent placement for HVOO. 9,13,15,16,25,26 Buell et al 16 reported a 72% success rate for stent placement. However, most of these reports have noted hesitation in performing stent placement in pediatric cases for several reasons.…”

Section: Discussionmentioning

confidence: 99%

“…However, most of these reports have noted hesitation in performing stent placement in pediatric cases for several reasons. 8,26 First, stents are susceptible to intimal hyperplasia, which may lead to recurrent stenosis. Second, a placed stent has a fixed diameter, and this can cause stenosis when a child grows.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto university experience

Sakamoto¹,

Egawa²,

Kanazawa³

et al. 2010

Liver Transpl

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The goals of this study were to evaluate the incidence of hepatic venous outflow obstruction (HVOO) in pediatric patients after living donor liver transplantation (LDLT) using left-sided lobe grafts and to assess the therapeutic modalities used for the treatment of this complication at a single center. Four hundred thirteen primary LDLT procedures were performed with left-sided lobe grafts between 1996 and 2006. All transplants identified with HVOO from a cohort of 380 grafts with survival greater than 90 days were evaluated with respect to the patient demographics, therapeutic intervention, recurrence, and outcome. Seventeen cases (4.5%) were identified with HVOO. Eight patients experienced recurrence after the initial balloon venoplasty. Two patients finally required stent placement after they experienced recurrence shortly after the initial balloon venoplasty. A univariate analysis revealed that a smaller recipient-to-donor body weight ratio and the use of reduced grafts were statistically significant risk factors. The cases with grafts with multiple hepatic veins had a higher incidence of HVOO. In conclusion, the necessity of repeated balloon venoplasty and stent placement was related to poor graft survival. Therefore, the prevention of HVOO should be a high priority in LDLT. When grafts with multiple hepatic veins and/or significant donor-recipient size mismatching are encountered, the use of a patch graft is recommended. Stent placement should be carefully considered because of the absence of data on the long-term patency of stents and stent-related complications. New stenting devices, such as drug-eluting and biodegradable stents, may be promising for the management of HVOO. Liver Transpl 16:1207-1214, 2010. V C 2010 AASLD.Received April 5, 2010; accepted July 2, 2010.Techniques for reduced size liver transplantation, split liver transplantation, and living donor liver transplantation (LDLT) have been developed to address the shortage of organs and the size discrepancy between donors and recipients. 1,2 These types of liver transplantation are technically demanding because of the use of short vascular pedicles, which are more likely to cause postoperative vascular complications. Hepatic venous outflow obstruction (HVOO) is a rare vascular complication; however, it may lead to graft dysfunction without appropriate management. 3,4 The causes of HVOO include technical problems, subsequent fibrosis with inflammatory processes, and compression or twisting of the anastomosis caused by Abbreviations: BA, biliary atresia; GRWR, graft-to-recipient weight ratio; HVOO, hepatic venous outflow obstruction; IVC, inferior vena cava; LDLT, living donor liver transplantation; LL, left lobe; LLS, left lateral segment; r-LLS, reduced left lateral segment; SD, standard deviation; WD, Wilson's disease.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto university experience

Sakamoto¹,

Egawa²,

Kanazawa³

et al. 2010

Liver Transpl

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“…6 Stents have usually been used to treat elastic or recurrent stenosis following balloon angioplasty, [7][8][9][10] and there have been a few reports dealing with the long-term (Ͼ1 year) patency of stent-inserted hepatic veins in LDLT. 7,[11][12][13] We believe that primary stent placement is the treatment of choice to manage early (Յ4 weeks) posttransplant hepatic venous outflow abnormalities.…”

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confidence: 99%

Early posttransplant hepatic venous outflow obstruction: Long-term efficacy of primary stent placement

et al. 2008

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Although balloon angioplasty has been accepted as the safe and effective initial treatment to manage hepatic venous outflow abnormalities, it may induce rupture of the fresh anastomosis but also may be ineffective to eliminate various etiologies of venous outflow abnormalities in the early post-transplant period. Therefore, we performed primary stent placement in 108 patients to treat early-onset (Յ4 weeks) post-transplant hepatic venous outflow abnormality. The following parameters were documented retrospectively: technical success and complications: clinical success; recurrence; and patency of stent-inserted hepatic veins.Technical success was achieved in 166 (97.6%) of 170 anastomoses (107 patients). Major complications occurred in 5 (4.6%) patients: partial stent migration (n ϭ 2) and stent malposition (n ϭ 3). Clinical success was achieved in 83 (82.2%) of 101 patients who had abnormal liver enzymes or clinical symptoms. Seven patients without initial clinical symptoms have remained healthy. Restenosis or occlusion of the stent-inserted hepatic veins was documented in 22 patients at a mean of 9.6 Ϯ 8.6 months after stent placement. Four of them underwent stent replacement or retransplantation due to liver function deterioration. Overall 1-, 3-, and 5-year primary patency rates were 82.3 Ϯ 0.3%, 75.0 Ϯ 0.4%, and 72.4 Ϯ 0.5%, respectively. Multivariate Cox regression analysis showed that diameter of stents was an independent factor associated with patency of stents (p ϭ 0.001).Primary stent placement seems to be an effective treatment modality with an acceptable long-term patency to treat early post-transplant hepatic venous outflow obstruction. Liver Transpl 14: 1505-1511, 2008.

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“…Although HVOO is an uncommon complication after liver transplantation, it is still an important cause of graft failures after liver transplantation [2] . The incidence of HVOO after orthotropic liver transplantation is reported to be about 1% and that after LDLT is reported to be about 2-4% [11,12] . This is because an anastomotic orifice is small and the grafts grow in LDLT.…”

Section: Ir For Hvoomentioning

confidence: 99%

Interventional radiology for post-transplant anastomotic complications

Shibata¹

2017

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How to cite this article: Shibata T. Interventional radiology for post-transplant anastomotic complications. Hepatoma Res 2017;3:221-7.The effectiveness of percutaneous interventional radiology for anastomotic stricture in hepatic vein, portal vein, and biliary tract after living donor liver transplantation (LDLT) is described. As a number of patients with LDLT are infants < 10-year-old in the study, the first treatment option was balloon dilatation, not primary stenting. However, stent placement was performed in patients with recurrent, repeated stenosis. Key words:Interventional radiology, living donor liver transplantation, balloon dilatation, stent placement ABSTRACTArticle history:

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Endovascular Treatment of Hepatic Venous Outflow Obstruction after Living-donor Liver Transplantation

Cited by 108 publications

References 19 publications

Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto university experience

Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto university experience

Early posttransplant hepatic venous outflow obstruction: Long-term efficacy of primary stent placement

Interventional radiology for post-transplant anastomotic complications

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