Complementary Indicators for Diagnosis of Hepatic Vein Stenosis After Pediatric Living-donor Liver Transplantation.
BACKGROUND
Although hepatic vein stenosis after liver transplantation is a rare complication, the complication rate of 1% to 6% is higher in pediatric living-donor liver transplantation than that in other liver transplantation cases. Diagnosis is very important because this complication can cause hepatic congestion that develops to liver cirrhosis, graft loss, and patient loss. However, this is unlikely in cases where there are no ascites or hypoalbuminemia.


OBJECTIVE
Eleven of 167 patients who had undergone pediatric living-donor liver transplantation were identified in the outpatient clinic at Jichi Medical University as having suffered from hepatic vein stenosis, and were enrolled in the study.


METHODS
We conducted a retrospective study in which we reviewed historical patient records to investigate the parameters for diagnosis and examine treatment methods and outcomes.


RESULTS
The 11 patients were treated with 16 episodes of balloon dilatation. Three among these received retransplantation and another 2 cases required the placement of a metallic stent at the stenosis. Histological examination revealed severe fibrosis in four of nine patients who had a liver biopsy, with mild fibrosis revealed in the other five grafts. Furthermore, hepatomegaly and splenomegaly diagnosed by computed tomography, elevated levels of hyarulonic acid, and/or a decrease in calcineurin inhibitor clearance were found to be pathognomonic at diagnosis, and tended to improve after treatment.


CONCLUSIONS
Diagnosis of hepatic vein stenosis after liver transplantation can be difficult, so careful observation is crucial to avoid the risk of acute liver dysfunction. Comprehensive assessment using volumetry of the liver and spleen and monitoring of hyarulonic acid levels and/or calcineurin inhibitor clearance, in addition to some form of imaging examination, is important for diagnosis and evaluation of the effectiveness of therapy.
Department of Surgery, Nippon Medical School, Tokyo, Japan. Electronic address: y-kawano@nms.ac.jp.
Y
Y
Kawano
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
K
K
Mizuta
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
Y
Y
Sanada
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
T
T
Urahashi
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
Y
Y
Ihara
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
N
N
Okada
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
N
N
Yamada
Department of Surgery, Jichi Medical University, Tochigi, Japan.
H
H
Sasanuma
Department of Surgery, Jichi Medical University, Tochigi, Japan.
Y
Y
Sakuma
Department of Surgery, Nippon Medical School, Tokyo, Japan.
N
N
Taniai
Department of Surgery, Nippon Medical School, Tokyo, Japan.
H
H
Yoshida
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
H
H
Kawarasaki
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
Y
Y
Yasuda
Department of Surgery, Nippon Medical School, Tokyo, Japan.
E
E
Uchida
D000293:Adolescent; D000465:Algorithms; D065095:Calcineurin Inhibitors / Q000378:metabolism; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D004106:Dilatation; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006529:Hepatomegaly / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D007223:Infant; D008103:Liver Cirrhosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging*; D012086:Reoperation; D012189:Retrospective Studies; D013163:Splenomegaly / Q000150:complications / Q000000981:diagnostic imaging*; D015607:Stents; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler
D065095:Calcineurin Inhibitors; D006820:Hyaluronic Acid