Venous Outflow Obstruction Following Living Donor Liver Transplantation: Analysis of 1011 Liver Transplant Cases


KOÇ S., AKBULUT A. S. , SOYER V., YILMAZ M. , BARUT B. , KUTLU R. , ...More

The 2017 Joint International Congress of ILTS, Elite& Licage, Prague, Czech Republic, 24 - 27 May 2017, vol.101, pp.129-130

  • Publication Type: Conference Paper / Full Text
  • Volume: 101
  • City: Prague
  • Country: Czech Republic
  • Page Numbers: pp.129-130

Abstract

Background: To share our management approach for cases of hepatic venous outlet obstruction (HVOO) following living donor liver transplantation (LDLT).
Methods: Between November 2007 and April 2014, 1011 patients underwent LDLT at the our Liver Transplantation Institute and 35 (3.46%) developed posttransplant HVOO. The demographic, clinical and radiological data of the patients with posttransplant HVOO were reviewed retrospectively. For analysis, the patients with HVOO were subgrouped on the basis of the timing of HVOO [early onset (< 30 days): n=8 and late onset (≥30 days): n=27] and survival status (alive: n=24 and dead: n=11).
Results: The 35 patients with HVOO ranged in age from 1 year to 61 years, and included 24 adult patients and 11 pediatric patients. All adult patients had undergone right lobe LDLT; the pediatric patients had undergone left lateral segment LDLT (n=8) or left lobe LDLT (n=3). Nineteen of the adult patients and all 11 of the pediatric patients underwent hepatic venous reconstruction, with all procedures based on common large-opening drainage models using various vascular graft materials. Development of HVOO occurred at post-LDLT day 233±298.5 in the adult patients and day 139±97.8 in the pediatric patients. Following HVOO development, the patients underwent 1-6 (1.5±1.1) sessions of balloon angioplasty. After the first balloon angioplasty procedure, 25% of the adults and 36.3% of the pediatric patients developed recurrence. The early-onset and lateonset
subgroups showed statistically significant differences in serum albumin (p=0.01), underlying causes (p=0.0001), time from LT to HVOO (p=0.02), and time from LT to last visit (p=0.02). The survivor and non-survivor subgroups showed statistically significant differences in total bilirubin (p=0.03) and time from LT to last visit (p=0.03).
Conclusion: Use of common large opening reconstruction models minimizes HVOO development following LDLT. Balloon angioplasty and/or stenting is almost always the first option in the management of post-LDLT HVOO.