Hepatic venous outflow obstruction after adult living donor liver transplantation

Abstract

Hepatic venous outflow obstruction (HVOO) is a rare but critical vascular complication after adult living donor liver transplantation. We categorized HVOOs according to their morphology (anastomotic stenosis, kinking, intrahepatic stenosis) and onset (early-onset < 3 mo vs. late-onset ≥ 3 mo). Overall, 16/324 (4.9%) patients developed HVOO between 2000 and 2020. Fifteen patients underwent interventional radiology. Of the 16 hepatic venous anastomoses within these 15 patients, 12 were anastomotic stenosis, 2 were kinking, and 2 were intrahepatic stenoses. All of the kinking and intrahepatic stenoses required stent placement, but most of the anastomotic stenoses (11/12, 92%) were successfully managed with balloon angioplasty, which avoided stent placement. Graft survival tended to be worse for patients with late-onset HVOO than early-onset HVOO (40% vs. 69.3% at 5 y, p = 0.162) despite successful interventional radiology. In conclusion, repeat balloon angioplasty can be considered for simple anastomotic stenosis, but stent placement is recommended for kinking or intrahepatic stenosis. Close follow-up is recommended in patients with late-onset HVOO even after successful treatment.

Letter to the Editor: Blocked drain switch—hepatic venous outflow obstruction

“…Balloon angioplasty and/or stent placement have become the primary treatment for HVOO after liver transplantation. The recent study by Sambommatsu et al, [1] published in Liver Transplantation, analyzing the clinical data from 16/324 (4.9%) patients with HVOO, underscored the morphology of HVOO and corresponding treatment plan. They recommended repeat balloon angioplasty be considered for simple anastomotic stenosis, but stent placement was recommended for kinks or intrahepatic stenosis.…”

Reply: Blocked drain switch—hepatic venous outflow obstruction

“…To the editor, We thank Dr. Guo and colleagues for their interest in our manuscript published in Liver Transplantation regarding hepatic venous outflow obstruction after adult living donor liver transplantation. [1] They discussed 2 different choices of venous access (femoral and internal jugular) and highlighted the differences in procedurerelated risks and successful rates of these 2 accesses. They suggested that we should provide more information about the selection of interventional radiology access to guide clinical practice.…”