Hepatic venous outflow obstruction after adult living donor liver transplantation.

Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 100909185 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-6473 (Electronic) Linking ISSN: 15276465 NLM ISO Abbreviation: Liver Transpl Subsets: MEDLINE

Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc.
Original Publication: Philadelphia, PA : W.B. Saunders Co., c2000-

Budd-Chiari Syndrome*/diagnostic imaging ; Budd-Chiari Syndrome*/etiology ; Budd-Chiari Syndrome*/therapy ; Liver Transplantation*/adverse effects ; Angioplasty, Balloon*/adverse effects; Humans ; Adult ; Constriction, Pathologic/etiology ; Constriction, Pathologic/therapy ; Living Donors ; Treatment Outcome ; Stents/adverse effects ; Hepatic Veins/diagnostic imaging ; Hepatic Veins/surgery

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, and 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.
(Copyright © 2023 American Association for the Study of Liver Diseases.)

Comment in: Liver Transpl. 2024 Jan 1;30(1):E1-E2. (PMID: 37678217)

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Date Created: 20230804 Date Completed: 20231113 Latest Revision: 20240307

20240307

10.1097/LVT.0000000000000234

37540170