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  • Title: Hepatic venous outflow obstruction after adult living donor liver transplantation.
    Author: Sambommatsu Y, Hirukawa K, Shimata K, Honda M, Sakurai Y, Ishii M, Ibuki S, Isono K, Irie T, Kawabata S, Hirao H, Sugawara Y, Tamura Y, Ikeda O, Hirai T, Inomata Y, Morinaga J, Hibi T.
    Journal: Liver Transpl; 2023 Dec 01; 29(12):1292-1303. PubMed ID: 37540170.
    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.
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