title: Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto University experience.
abstract: The goals of this study were to evaluate the incidence of hepatic venous outflow obstruction (HVOO) in pediatric patients after living donor liver transplantation (LDLT) using left-sided lobe grafts and to assess the therapeutic modalities used for the treatment of this complication at a single center. Four hundred thirteen primary LDLT procedures were performed with left-sided lobe grafts between 1996 and 2006. All transplants identified with HVOO from a cohort of 380 grafts with survival greater than 90 days were evaluated with respect to the patient demographics, therapeutic intervention, recurrence, and outcome. Seventeen cases (4.5%) were identified with HVOO. Eight patients experienced recurrence after the initial balloon venoplasty. Two patients finally required stent placement after they experienced recurrence shortly after the initial balloon venoplasty. A univariate analysis revealed that a smaller recipient-to-donor body weight ratio and the use of reduced grafts were statistically significant risk factors. The cases with grafts with multiple hepatic veins had a higher incidence of HVOO. In conclusion, the necessity of repeated balloon venoplasty and stent placement was related to poor graft survival. Therefore, the prevention of HVOO should be a high priority in LDLT. When grafts with multiple hepatic veins and/or significant donor-recipient size mismatching are encountered, the use of a patch graft is recommended. Stent placement should be carefully considered because of the absence of data on the long-term patency of stents and stent-related complications. New stenting devices, such as drug-eluting and biodegradable stents, may be promising for the management of HVOO.
authors.affiliation: Departments of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. sseisuke@kuhp.kyoto-u.ac.jp
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Toshiya
authors.initials: T
authors.lastname: Shibata
authors.forename: Aya
authors.initials: A
authors.lastname: Miyagawa-Hayashino
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Sinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000293:Adolescent; D006502:Budd-Chiari Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D002404:Catheterization / Q000295:instrumentation; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014495:Universities