Obstruction to hepatic venous drainage after liver transplantation: treatment with balloon angioplasty.

Zajko, Albert B.; Claus, D.; Clapuyt, P.; Esquivel, C. O.; Moulin, D.; Starzl, Thomas E.; Goyet, Jean de Ville de; Otte, Jean Bernard

doi:10.1148/radiology.170.3.2521735

Cited by 90 publications

(34 citation statements)

References 20 publications

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“…A l-yr-old girl developed a large right pleural effusion from suprahepatic stenosis of the inferior vena cava 4 mo after liver transplantation (81). She had substantial ascites, which the investigators thought was responsible for development of the effusion.…”

Section: Posttransplant Considerationsmentioning

confidence: 99%

The pleural space and organ transplantation.

Judson

Sahn²

1996

Am J Respir Crit Care Med

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Pleural disease both before and after organ transplantation has important implications. Pleural effusions are common in candidates for heart, liver, and kidney transplantation. A thoracentesis is not mandatory in these patients, but it should be performed if clinical or radiologic features suggest that the effusion is not the result of organ failure. Posttransplant pleural infections and pleural PTLD relate to the level and duration of immunosuppression and are probably not organ-specific. Organ-specific pleural complications include pleural effusion from hepatic venoocclusive disease, spontaneous pneumothorax associated with obstructive airway disease from chronic GVHD after bone marrow transplantation, and early pleural effusion from urinothorax and late effusion from perirenal lymphocele years after kidney transplantation. The treatment of pleural disease in potential lung transplant candidates should minimize the extent of pleurodesis. Pleural effusions are expected sequelae after lung transplantation, and they may be harbingers of acute rejection. Interpleural communication, an expected finding after heart-lung transplantation or double-lung transplantation with a "clamshell" incision, has therapeutic implications.

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Section: Posttransplant Considerationsmentioning

confidence: 99%

The pleural space and organ transplantation.

Judson

Sahn²

1996

Am J Respir Crit Care Med

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“…1,2 Balloon angioplasty has been accepted as a safe and effective initial treatment for managing hepatic venous outflow abnormalities following liver transplantation. [3][4][5] However, balloon angioplasty may induce rupture of the fresh anastomosis and also may be ineffective in eliminating various etiologies of venous outflow abnormalities in the early posttransplant period. 6 Stents have usually been used to treat elastic or recurrent stenosis following balloon angioplasty, [7][8][9][10] and there have been a few reports dealing with the long-term (Ͼ1 year) patency of stent-inserted hepatic veins in LDLT.…”

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confidence: 99%

Early posttransplant hepatic venous outflow obstruction: Long-term efficacy of primary stent placement

et al. 2008

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Although balloon angioplasty has been accepted as the safe and effective initial treatment to manage hepatic venous outflow abnormalities, it may induce rupture of the fresh anastomosis but also may be ineffective to eliminate various etiologies of venous outflow abnormalities in the early post-transplant period. Therefore, we performed primary stent placement in 108 patients to treat early-onset (Յ4 weeks) post-transplant hepatic venous outflow abnormality. The following parameters were documented retrospectively: technical success and complications: clinical success; recurrence; and patency of stent-inserted hepatic veins.Technical success was achieved in 166 (97.6%) of 170 anastomoses (107 patients). Major complications occurred in 5 (4.6%) patients: partial stent migration (n ϭ 2) and stent malposition (n ϭ 3). Clinical success was achieved in 83 (82.2%) of 101 patients who had abnormal liver enzymes or clinical symptoms. Seven patients without initial clinical symptoms have remained healthy. Restenosis or occlusion of the stent-inserted hepatic veins was documented in 22 patients at a mean of 9.6 Ϯ 8.6 months after stent placement. Four of them underwent stent replacement or retransplantation due to liver function deterioration. Overall 1-, 3-, and 5-year primary patency rates were 82.3 Ϯ 0.3%, 75.0 Ϯ 0.4%, and 72.4 Ϯ 0.5%, respectively. Multivariate Cox regression analysis showed that diameter of stents was an independent factor associated with patency of stents (p ϭ 0.001).Primary stent placement seems to be an effective treatment modality with an acceptable long-term patency to treat early post-transplant hepatic venous outflow obstruction. Liver Transpl 14: 1505-1511, 2008.

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“…3,4 Decreased liver vascular compliance during acute cellular rejection 5,6 or the use of reduced grafts 7 causing inadequate accommodation of liver blood flow have also been proposed as mechanisms of ascites formation in liver transplant recipients. Recently, Gane et al 8 reported a series of liver transplant recipients who developed massive ascites and coagulation disturbances associated with an underlying hypercoagulable state, but no information on the outcome of these patients was given.…”

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confidence: 99%

Ascites after liver transplantation

et al. 2000

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Massive ascites after liver transplantation, although uncommon, usually represents a serious adverse event. The pathogenesis of this complication has not been adequately investigated. To determine the incidence, characteristics, and pathogenic factors of massive ascites after liver transplantation (ascitic fluid G 500 mL/d for G10 days), the charts of 378 liver transplant recipients were reviewed. Massive ascites occurred in 25 patients (7%). Mean ascitic fluid production was 960 mL/d (range, 625 to 2,350 mL/d), and the duration of ascites was 77 days (range, 15 to 223 days). The ascitic fluid had a high protein content (36 ؎ 7 g/L; range, 25 to 50 g/L). When patients who did and did not develop massive ascites were compared, significant differences were found in receptor sex (men, 88% v 60%, respectively; P F .01) and surgical technique (inferior vena cava preservation with piggyback technique, 72% v 41%; P F .01). Significantly increased wedged and free hepatic venous pressures and gradients between hepatic vein and right atrial pressures were found in patients who developed ascites, suggesting a difficulty in graft blood outflow. Massive ascites was associated with renal impairment, increased incidence of abdominal infection, prolonged hospitalization, and a tendency toward reduced survival. In conclusion, massive ascites after liver transplantation is relatively uncommon but associated with increased morbidity and mortality and is predominantly related to difficulties of hepatic venous drainage. Measurement of hepatic vein and atrial pressures to detect a significant gradient and correct possible alterations in hepatic vein outflow should be the first approach in the management of these patients.

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Obstruction to hepatic venous drainage after liver transplantation: treatment with balloon angioplasty.

Cited by 90 publications

References 20 publications

The pleural space and organ transplantation.

The pleural space and organ transplantation.

Early posttransplant hepatic venous outflow obstruction: Long-term efficacy of primary stent placement

Ascites after liver transplantation

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