Ann Surg Treat Res.  2018 Dec;95(6):333-339. 10.4174/astr.2018.95.6.333.

Long-term outcomes after stent insertion in patients with early and late hepatic vein outflow obstruction after living donor liver transplantation

• Kim KS
• Lee JS
• Choi GS
• Kwon CH
• Cho JW
• Lee SK
• Park KB
• Cho SK
• Shin SW
• Kim JM

• KMID: 2426765
• DOI: http://doi.org/10.4174/astr.2018.95.6.333

Abstract

PURPOSE
The purpose of this study was to describe the long-term effects of stenting in patients with hepatic venous outflow obstruction (HVOO), who underwent living donor liver transplantation (LDLT).
METHODS
Between January 2000 and December 2009, 622 adult patients underwent LDLT at our hospital, and of these patients, 21 (3.3%) were diagnosed with HVOO; among these patients, 17 underwent stenting. The patients were divided into early or late groups according to the time of their HVOO diagnoses (cutoff: 60 days after liver transplantation).
RESULTS
The median follow-up period was 54.2 months (range, 0.5-192.4 months). Stent insertion was successful in 8 of 10 patients in the early group and 6 of 7 in the late group. The 5-year primary patency rates were 46% and 20%, respectively. In both groups, patients with recurrent HVOO at the beginning showed kinking confirmed by venography. Patients who carried their stents for more than 3 years maintained long-term patency. There was no significant difference in spleen size between groups; however, when the groups were compared according to whether they maintained patency, spleens tended to be smaller in the patency-maintained group.
CONCLUSION
Unlike stenosis, if kinking is confirmed on venography, stenting is not feasible in the long term for patients with LDLT.

Keyword

Liver transplantation; Hepatic veins; Complications; Stents

MeSH Terms

Adult
Budd-Chiari Syndrome
Constriction, Pathologic
Diagnosis
Follow-Up Studies
Hepatic Veins*
Humans
Liver Transplantation*
Liver*
Living Donors*
Phlebography
Spleen
Stents*

Figure

• 

  Fig. 1 Flowchart showing the incidence of hepatic venous outflow obstruction and treatment in adults who underwent living donor liver transplantation. HVOO, hepatic venous outflow obstruction; PTA, percutaneous transluminal angioplasty; reLT, reliver transplantation.

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  Fig. 2 Changes in pressure gradients across the obstructed lesions in early and late groups.

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  Fig. 3 Cumulative primary stent patency for hepatic venous outflow obstruction.

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  Fig. 4 Changes in spleen size of patients with tri/biphasic and monophasic waveforms.

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  Fig. 5 Changes in spleen size before and after stenting in early and late groups.

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