Hepatic venous outflow obstruction after adult living donor liver transplantation

Liver Transpl. 2023 Dec 1;29(12):1292-1303. doi: 10.1097/LVT.0000000000000234. Epub 2023 Aug 7.

Abstract

Hepatic venous outflow obstruction (HVOO) is a rare but critical vascular complication after adult living donor liver transplantation. We categorized HVOOs according to their morphology (anastomotic stenosis, kinking, and intrahepatic stenosis) and onset (early-onset < 3 mo vs. late-onset ≥ 3 mo). Overall, 16/324 (4.9%) patients developed HVOO between 2000 and 2020. Fifteen patients underwent interventional radiology. Of the 16 hepatic venous anastomoses within these 15 patients, 12 were anastomotic stenosis, 2 were kinking, and 2 were intrahepatic stenoses. All of the kinking and intrahepatic stenoses required stent placement, but most of the anastomotic stenoses (11/12, 92%) were successfully managed with balloon angioplasty, which avoided stent placement. Graft survival tended to be worse for patients with late-onset HVOO than early-onset HVOO (40% vs. 69.3% at 5 y, p = 0.162) despite successful interventional radiology. In conclusion, repeat balloon angioplasty can be considered for simple anastomotic stenosis, but stent placement is recommended for kinking or intrahepatic stenosis. Close follow-up is recommended in patients with late-onset HVOO even after successful treatment.

MeSH terms

  • Adult
  • Angioplasty, Balloon* / adverse effects
  • Budd-Chiari Syndrome* / diagnostic imaging
  • Budd-Chiari Syndrome* / etiology
  • Budd-Chiari Syndrome* / therapy
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / therapy
  • Hepatic Veins / diagnostic imaging
  • Hepatic Veins / surgery
  • Humans
  • Liver Transplantation* / adverse effects
  • Living Donors
  • Stents / adverse effects
  • Treatment Outcome