title: Portal vein stenosis: a rare yet clinically important cause of delayed-onset ascites after adult deceased donor liver transplantation: two case reports.
abstract: Vascular complications following liver transplantation are well documented. While complications involving the portal vein are less common than the hepatic artery, portal vein complications can lead to potentially life-threatening sequelae including graft loss. Portal vein stenosis is an infrequent complication following liver transplant. The majority of these complications are seen in living donor liver transplants and pediatric liver transplants. We present 2 cases of delayed onset portal vein stenosis in adult deceased donor liver transplantation (ADDLT). The first patient presented with refractory ascites twelve months after ADDLT. He was diagnosed and successfully treated with percutaneous transhepatic portovenography and venoplasty. The second patient had a history of irradiation to his portal bed in the setting of cholangiocarcinoma. He developed refractory ascites and esophageal variceal bleeding>2 years after ADDLT. He underwent percutaneous transhepatic portovenoplasty, but eventually required placement of a portal stent due to continued problems with recurrent ascites. These 2 cases highlight the importance of considering portal vein stenosis in the differential diagnosis of late-onset ascites following liver transplantation, especially if there have been any predisposing risk factors such as portal bed irradiation or prior splenectomy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Vanderbilt University Medical School, Vanderbilt Digestive Disease Center, The Vanderbilt Clinic, Nashville, Tennessee 37232-5280, USA. natasha.schneider@vanderbilt.edu
authors.forename: N
authors.initials: N
authors.lastname: Schneider
authors.forename: A
authors.initials: A
authors.lastname: Scanga
authors.forename: L
authors.initials: L
authors.lastname: Stokes
authors.forename: R
authors.initials: R
authors.lastname: Perri
mesh_terms: D001201:Ascites / Q000209:etiology* / Q000628:therapy; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000295:instrumentation; D004932:Esophageal and Gastric Varices / Q000209:etiology; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy