Long‐term follow‐up after endovascular treatment of hepatic venous outflow obstruction following liver transplantation. (13th September 2016)

• Record Type: Journal Article
• Authors: Pitchaimuthu, Maheswaran; Roll, Garrett R.; Zia, Zergham; Olliff, Simon; Mehrzad, Homoyoon; Hodson, James; Gunson, Bridget K.; Perera, M. Thamara P. R.; Isaac, John R.; Muiesan, Paolo; Mirza, Darius F.; Mergental, Hynek
• Is Part Of: Transplant international. Volume 29:Number 10(2016)
• Page Start: 1106
• Page End: 1116
• Publication Date: 2016-09-13
• Subjects: hepatic vein stent -- hepatic venogram -- hepatic venoplasty -- hepatic venous outflow obstruction -- liver transplantation -- piggyback technique; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.12817
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: Hepatic venous outflow obstruction (HVOO) is a rare complication after liver transplantation (LT) associated with significant morbidity and reduced graft survival. Endovascular intervention has become the first‐line treatment for HVOO, but data on long‐term outcomes are lacking. We have analysed outcomes after endovascular intervention for HVOO in 905 consecutive patients who received 965 full‐size LT at our unit from January 2007 to June 2014. There were 27 (3%) patients who underwent hepatic venogram for suspected HVOO, with persistent ascites being the most common symptom triggering the investigation ( n = 19, 70%). Of those, only 10 patients demonstrated either stricture or pressure gradient over 10 mmHg on venogram, which represents a 1% incidence of HVOO. The endovascular interventions were balloon dilatation ( n = 3), hepatic vein stenting ( n = 4) and stenting with dilatation ( n = 3). Two patients required restenting due to stent migration. The symptoms of HVOO completely resolved in all but one patient, with a median follow‐up period of 74 (interquartile range 39–89) months. There were no procedure‐related complications or mortality. In conclusion, the incidence of HVOO in patients receiving full‐size LT is currently very low. Endovascular intervention is an effective and safe procedure providing symptom relief with long‐lasting primary patency.