title: Long-term follow-up after endovascular treatment of hepatic venous outflow obstruction following liver transplantation.
abstract: Hepatic venous outflow obstruction (HVOO) is a rare complication after liver transplantation (LT) associated with significant morbidity and reduced graft survival. Endovascular intervention has become the first-line treatment for HVOO, but data on long-term outcomes are lacking. We have analysed outcomes after endovascular intervention for HVOO in 905 consecutive patients who received 965 full-size LT at our unit from January 2007 to June 2014. There were 27 (3%) patients who underwent hepatic venogram for suspected HVOO, with persistent ascites being the most common symptom triggering the investigation (n = 19, 70%). Of those, only 10 patients demonstrated either stricture or pressure gradient over 10 mmHg on venogram, which represents a 1% incidence of HVOO. The endovascular interventions were balloon dilatation (n = 3), hepatic vein stenting (n = 4) and stenting with dilatation (n = 3). Two patients required restenting due to stent migration. The symptoms of HVOO completely resolved in all but one patient, with a median follow-up period of 74 (interquartile range 39-89) months. There were no procedure-related complications or mortality. In conclusion, the incidence of HVOO in patients receiving full-size LT is currently very low. Endovascular intervention is an effective and safe procedure providing symptom relief with long-lasting primary patency.
authors.affiliation: Liver Unit Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Maheswaran
authors.initials: M
authors.lastname: Pitchaimuthu
authors.affiliation: Liver Unit Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|Division of Transplant Surgery, University of California, San Francisco, CA, USA.
authors.forename: Garrett R
authors.initials: GR
authors.lastname: Roll
authors.affiliation: Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Zergham
authors.initials: Z
authors.lastname: Zia
authors.affiliation: Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Olliff
authors.affiliation: Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Homoyoon
authors.initials: H
authors.lastname: Mehrzad
authors.affiliation: National Institute for Health Research Birmingham, Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: James
authors.initials: J
authors.lastname: Hodson
authors.affiliation: National Institute for Health Research Birmingham, Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.affiliation: Liver Unit Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: M Thamara P R
authors.initials: MT
authors.lastname: Perera
authors.affiliation: Liver Unit Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Isaac
authors.affiliation: Liver Unit Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: Liver Unit Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|National Institute for Health Research Birmingham, Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
authors.affiliation: Liver Unit Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. hynek.mergental@uhb.nhs.uk.|National Institute for Health Research Birmingham, Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. hynek.mergental@uhb.nhs.uk.
authors.forename: Hynek
authors.identifier: http://orcid.org/0000-0001-5480-9380
authors.initials: H
authors.lastname: Mergental
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D007165:Immunosuppression Therapy; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: hepatic vein stent; hepatic venogram; hepatic venoplasty; hepatic venous outflow obstruction; liver transplantation; piggyback technique