Long-term follow-up after endovascular treatment of hepatic venous outflow obstruction following liver transplantation

Abstract

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.

Novel use of percutaneous thrombosuction to rescue the early thrombosis of the conduit vein graft after living donor liver transplantation

“… 2 , 3 , 7 , 8 , 13 , 14 The common nonsurgical treatment options include various endovascular treatments, such as balloon angioplasty or stent placement (or both), percutaneous transluminal venoplasty, and stent placement. 2 , 3 , 4 , 8 , 9 , 13 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 The potential complications of these treatments include failure, malposition, infection, lifelong anticoagulant therapy-related issues, stent migration, and reocclusion. 2 , 3 , 4 , 12 , 15 , 16 , 17 , 20 , 21 Sakamoto et al 13 emphasized that progression of fibrosis could not be prevented if the timing of stenting is too late.…”

Portal Hypertension after Liver Transplantation—Causes and Management

“…Irrespective of the established technique, a sufficiently wide lumen is essential, although intervention is rarely necessary. In a recently published study, only approximately 1% of patients undergoing OLT required endovascular treatment of HVOO [51]. Treatment was successful in 9/10 patients and consisted of balloon dilation, stent implantation, or a combination of both.…”

Liver Transplantation

“…Patient symptoms/signs include the need for ongoing diuretic therapy, persistent ascites, or abnormal liver function tests. Persistent ascites has been found to be the most common symptom resulting in investigation for hepatic venous outflow obstruction [135]. Untreated hepatic venous outflow obstruction (HVOO) can lead to graft congestion, portal hypertension, and cirrhosis, which may ultimately compromise graft function and patient survival [136].…”