Outcome of percutaneous transhepatic venoplasty for hepatic venous outflow obstruction after living donor liver transplantation.
OBJECTIVE
To evaluate retrospectively the outcome of percutaneous transhepatic venoplasty of hepatic venous outflow obstruction after living donor liver transplantation (LDLT).


METHODS
The institutional Human Subjects Research Review Board approved the interventional protocol and the retrospective study, for which informed consent was not required. Before treatment, informed consent was obtained from the patient or the patient's parents in all cases. Of 26 consecutive patients (nine male, 17 female; median age, 9 years) suspected of having hepatic venous outflow obstruction after LDLT, 20 patients confirmed to have anastomotic outflow stenosis at percutaneous hepatic venography and manometry underwent venoplasty. Pressure gradients before and after venoplasty were evaluated by using a paired t test. Patients in whom obstruction recurred during follow-up were re-treated with venoplasty with or without expandable metallic stents. Patency was analyzed by using Kaplan-Meier analysis.


RESULTS
The initial balloon venoplasty was technically successful in all 20 patients, all of whom had improved clinical findings. The pressure gradient +/- standard deviation was reduced from 14.6 mg Hg +/- 8.6 to 2.2 mg Hg +/- 2.4 (P < .001). Eleven patients had recurrent obstruction and were treated with balloon venoplasty; one of them underwent stent placement, as well as venoplasty. The primary (event-free) patency and 95% confidence interval (CI) at 3, 12, and 60 months after venoplasty were 0.80 (95% CI: 0.62, 0.98), 0.60 (95% CI: 0.38, 0.81), and 0.60 (95% CI: 0.38, 0.81), respectively. The primary assisted patency, maintained with repeated venoplasty and expandable metallic stents, was 1.00 at 60 months.


CONCLUSIONS
Percutaneous venoplasty is an effective treatment for hepatic venous outflow obstruction after LDLT.
Department of Radiology, Kyoto University Graduate School of Medicine, 54-Kawaharacho, Shogoin, Sakyoku, Kyoto 606-8507, Japan.
Takeshi
T
Kubo
Toshiya
T
Shibata
Kyo
K
Itoh
Yoji
Y
Maetani
Hiroyoshi
H
Isoda
Masahiro
M
Hiraoka
Hiroto
H
Egawa
Koichi
K
Tanaka
Kaori
K
Togashi
D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology* / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods