Hepatic venous outflow obstruction after transplantation: outcomes for treatment with self-expanding stents.
OBJECTIVE
To evaluate the safety and patency of self-expanding stents to treat hepatic venous outflow obstruction after orthotopic liver transplantation. To evaluate differences in the response between patients with early obstruction and patients with late obstruction.


METHODS
This is a retrospective analysis of 16 patients with hepatic venous outflow obstruction after liver transplantation treated with stents (1996-2011). Follow-up included venography/manometry, ultrasonography, CT, and laboratory tests. We did a descriptive statistical analysis of the survival of patients and stents, technical and clinical success of the procedure, recurrence of obstruction, and complications of the procedure. We also did an inferential statistical analysis of the differences between patients with early and late obstruction.


RESULTS
The mean follow-up period was 3.34 years (21-5,331 days). The technical success rate was 93.7%, and the clinical success rate was 81.2%. The rate of complications was 25%. The survival rates were 87.5% for patients and 92.5% for stents. The rate of recurrence was 12.5%. The rate of primary patency was 0.96 (95% CI 0.91-1) at 3 months, 0.96 (95% CI 0.91-1) at 6 months, 0.87 (95% CI 0.73-1) at 12 months, and 0.87 (95% CI 0.73-1) at 60 months. There were no significant differences between patients with early and late obstruction, although there was a trend toward higher rates of primary patency in patients with early obstruction (P=.091).


CONCLUSIONS
Treating hepatic venous outflow obstruction after orthotopic transplantation with self-expanding stents is effective, durable, and effective. There are no significant differences between patients with early obstruction and those with late obstruction.
Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España. Electronic address: gviteri@gmail.com.
G
G
Viteri-Ramírez
Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España; Servicio de Radiología, Fundación Jiménez Díaz, Madrid, España.
A
A
Alonso-Burgos
Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España.
I
I
Simon-Yarza
Servicio de Cirugía General y Abdominal, Clínica Universidad de Navarra, Pamplona, España.
F
F
Rotellar
Unidad de Hepatología, Clínica Universidad de Navarra, Pamplona, España.
J I
JI
Herrero
Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, España.
J I
JI
Bilbao
D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000601:surgery; D057510:Endovascular Procedures; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
Complicaciones; Complications; Endoprótesis; Endovascular treatment; Hepatic veins; Liver transplant; Stent; Trasplante hepático; Tratamiento endovascular; Venas suprahepáticas