Management of venous stenosis in living donor liver transplant recipients.
OBJECTIVE
To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation (LDLT).


METHODS
From February 1999 to May 2009, 1 intraoperative hepatic vein (HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT recipients. Postoperative portal vein (PV) anastomotic stenosis occurred in 1 pediatric left lobe LDLT. Patients ranged in age from 9 to 56 years (median, 44 years). An air balloon was used to correct the intraoperative HV tension. Emergent surgical reoperation, transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3, 15, 50, 55, and 270 after LDLT, respectively. Balloon dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after LDLT.


RESULTS
The intraoperative HV tension was corrected with an air balloon. The recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d later. HV balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all patients. The patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared, while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk later. Two patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites, respectively. Balloon dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT, and this patient has survived for 9 mo without recurrent PV stenosis and ascites.


CONCLUSIONS
Intraoperative balloon placement, emergent reoperation, proper interventional balloon dilatation and stent placement can be effective as a way to manage hepatic and PV stenosis during and after LDLT.
Yang
Jie
J
Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Xu
Ming-Qing
MQ
Yan
Lu-Nan
LN
Lu
Wu-Sheng
WS
Li
Xiao
X
Shi
Zheng-Rong
ZR
Li
Bo
B
Wen
Tian-Fu
TF
Wang
Wen-Tao
WT
Yang
Jia-Ying
JY
D000328:Adult; D000714:Anastomosis, Surgical; D002404:Catheterization / Q000295:instrumentation; D002648:Child; D003251:Constriction, Pathologic; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D051437:Renal Insufficiency / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality