Hepatic Venous Outflow Obstruction in Living Donor Liver Transplantation: Balloon Angioplasty or Stent Placement?

Umehara, Minoru; Narumi, Shunji; Sugai, Michihiro; Toyoki, Yoshikazu; Ishido, Keinosuke; Kudo, Daisuke; Kimura, Norihisa; Kobayashi, Takao; Hakamada, Kenichi

doi:10.1016/j.transproceed.2012.01.048

Cited by 37 publications

(47 citation statements)

References 5 publications

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“…Some authors have advocated a pressure gradient > 3 mm Hg as criterion for treatment planning, whereas others have indicated that that levels should be > 5 to 6 mm Hg. 3,4,6,8 The most important limitation of the present study is the lack of any gradient measurement for making the diagnosis of HVOO; unfortunately, our radiology unit lacks a manometry device for measuring that pressure gradient. Thus, we diagnosed HVOO and rated the success of the balloon angioplasty or stenting procedure on the basis of the view of a radiologist with 10 years of experience in interventional radiology, along with analyses of postprocedural clinical/radiologic data.…”

Section: Discussionmentioning

confidence: 96%

“…3,4 Whereas the reported incidences of post-LDLT HVOO range between 2% and 16.6%, the reported incidence of post-DDLT is substantially lower, ranging from 0.8% to 2.5%. 3,8 When considering graft type, the post-LDLT HVOO incidence ranges between 0.8% and 8.8% for right lobe and between 4.5% and 12.5% for left lobe/left lobe lateral segment. 6,9,10 Our Liver Transplant Institute had an overall incidence of post-LDLT HVOO of 3.46% (2.8% for adults and 7.4% for children).…”

Section: Discussionmentioning

confidence: 99%

“…8,11 The foremost and most commonly used noninvasive diagnostic tools for radiologic diagnosis are Doppler ultrasonography and multidetector CT, with the latter having both a greater sensitivity (87% vs 97%) and greater specificity (68% vs 86%), as well as offering excellent spatial resolution for parenchymal changes suggestive of venous congestion on portal and delayed phase images. 4 In cases with equivocal diagnosis or those that require intervention, conventional angiography is the procedure of choice.…”

Section: Discussionmentioning

confidence: 99%

“…3,4,6,12 The clinical success rates reported range between 82.2% and 90%. 3,6,8 The patency rates at postprocedure months are reported as 78% for 1 month, 67% to 80% for 3 months, 65% to 67% for 6 months, 56% to 82.3% for 12 months, 57% to 75% for 36 months, 56% to 72.4% for 60 months, and 52% for 120 months. 3,6,8,12 Among the patients presented here, 48.6% completely recovered after the first angioplasty procedure and did not require a repeat angioplasty; however, 70% of patients with earlyonset HVOO completely recovered with repeat angioplasty/stenting.…”

Section: Discussionmentioning

confidence: 99%

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

Koç

Akbulut²,

Soyer³

et al. 2021

Exp Clin Transplant

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Objectives: In this study, we share our approach for care of patients with hepatic venous outlet obstruction after living-donor liver transplant. Results: Patients ranged in age from 1 to 61 years (24 adults and 11 children). All adult patients had undergone right lobe living-donor liver transplant. In the pediatric group, 8 had undergone left lateral segment and 3 had undergone left lobe living-donor liver transplant. Nineteen adult patients and all 11 pediatric patients underwent hepatic venous reconstruction, with all procedures based on common large-opening drainage models using various vascular graft materials. Development of hepatic venous outlet obstruction occurred at mean posttransplant day 233 ± 298.5 in the adult patients and mean posttransplant day 139 ± 97.8 in the pediatric patients. After development of obstruction, the patients underwent 1-6 sessions (1.5 ± 1.1 sessions) of balloon angioplasty. After the first balloon angioplasty procedure, 25% of the adults and 36.3% of the pediatric patients developed recurrence. The early-onset and late-onset subgroups showed statistically significant differences in serum albumin (P = .01), underlying causes (P < .001), time from transplant to obstruction (P = .02), and time from transplant to last visit (P = .02). The survivor and nonsurvivor subgroups showed statistically significant differences in total bilirubin (P = .03) and time from transplant to last visit (P = .03). Conclusions: Common large-opening reconstruction minimizes hepatic venous outlet obstruction development after living-donor liver transplant. Balloon angioplasty and/or stenting is almost always the first option in the care of this complication. Materials and Methods Key words: Balloon angioplasty, Venous outflow, Venous reconstruction models IntroductionSince the time of the first successful liver transplant in humans (performed by Starzl and colleagues in 1967), liver transplant has emerged as the standard treatment option for a wide array of liver disorders and mainly those related to chronic liver diseases. [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.One of the most notable differences in the techniques is the reconstruction approach for venous outflow, which is necessary to ensure proper and adequate hepatic drainage. 3 In DDLT, various wide anastomoses are reconstructed between the donor's inferior vena cava (IVC) and the recipient's retrohepatic IVC; this approach lowers the rate of postoperative drainage complications to acceptable levels. In contrast, for LDLT, the reconstruction approach is complicated by the presence of multiple venous orifices in the liver grafts, as well as...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Koç

Akbulut²,

Soyer³

et al. 2021

Exp Clin Transplant

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“…HVOO is caused by stenosis or occlusion of the hepatic vein, leading to hepatic congestion and liver failure 5) . The incidence of HVOO after LDLT has been reported to be 5 -13% 10) , whereas the incidence after hepatectomy has been reported to be 0.1% 11) . In LDLT, HVOO usually occurs at the hepatic vein anastomotic site.…”

Section: Discussionmentioning

confidence: 99%

Remnant Left Lobe Torsion Causing Hepatic Venous Outflow Obstruction After Hepatic Right Lobectomy for Giant Hepatocellular Carcinoma: Report of a Case

Sato

Kenjo

Tsuchiya

et al. 2014

FJMS

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: We report the case of a 67 -year -old man with remnant left liver torsion causing acute hepatic venous outflow obstruction after right hepatectomy for giant hepatocellular carcinoma, which was successfully treated with surgery. After the primary surgery, he developed significant liver dysfunction and renal failure. Doppler ultrasonography disclosed gradual reduction of hepatic perfusion. Abdominal computed tomography revealed that the swollen remnant liver was dislocated in the right subphrenic space. After surgical repositioning of the left lobe into its anatomical position, the hepatic congestion immediately disappeared, and the hemodynamic parameters improved. The falciform and round ligaments were fixed to the anterior abdominal wall to keep the remnant liver in the anatomical position. His postoperative course was uneventful. Doppler ultrasonography was useful to assess hepatic perfusion for screening of acute hepatic venous outflow obstruction and abdominal computed tomography is definitive for diagnosis. Fixation of remnant liver may be effective for preventing hepatic venous outflow obstruction after right hepatectomy, particularly for giant tumor.

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Parenchyma sparing multicomponent liver resection strategy for multiple bilobar synchronous colorectal cancer metastasis

Burlaka

Kolesnik

2020

Clinical Case Reports

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Hepatic Venous Outflow Obstruction in Living Donor Liver Transplantation: Balloon Angioplasty or Stent Placement?

Cited by 37 publications

References 5 publications

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

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

Remnant Left Lobe Torsion Causing Hepatic Venous Outflow Obstruction After Hepatic Right Lobectomy for Giant Hepatocellular Carcinoma: Report of a Case

Parenchyma sparing multicomponent liver resection strategy for multiple bilobar synchronous colorectal cancer metastasis

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