Percutaneous Transhepatic Portal Vein Angioplasty for Portal Vein Stricture after Living Donor Liver Transplantation

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Abstract

Background

Liver transplantations have been widely performed with good outcome for patients with end-stage liver disease. However, complications associated with vascular reconstruction might result to graft liver failure and negatively impact on the outcome. These complications more frequently occur using a reduced-size graft such as a living donor because of an intrinsic short pedicle or a size mismatch of the graft vessel. Percutaneous transhepatic portal vein angioplasty (PTPA) is an alternative except for a surgical revision for the treatment of portal vein stricture. The aim of this study is to evaluate efficacy of PTPA for portal vein stricture after living donor liver transplantation (LDLT).

Patients and Methods

We have performed 303 LDLTs since June 1990 and experienced 35 cases (11.6%) of portal vein complications. Out of them, 11 recipients who underwent PTPA for portal vein stricture that occurred after LDLT were included in this study. The diagnosis of portal vein stricture was obtained based on the findings of contrast-enhanced CT and/or magnetic resonance imaging, in addition to symptoms arising from portal hypertension. PTPA was performed using the ultra-sonography-guided percutaneous transhepatic method. We inserted a catheter into a portal vein and placed a balloon catheter into the anastomotic stricture. After measuring the portal vein pressure, we dilated the stricture using balloons, starting from small diameter and then extending step by step till vanishing a notch, without inserting a vascular stent. We retrospectively evaluated the outcome and complications associated with this procedure.

Results

Eleven recipients aged from 5 months to 49 years old (median 18 years old) at the time of LDLT, had obtained a diagnosis of portal vein stricture median 3.4 years after LDLT. Portal vein pressure decreased and symptoms arising from portal hypertension improved via PTPAs in all recipients excluding one required stenting and another underwent revision of anastomosis after PTPA. Vascular patency was maintained during the follow-up period ranging from 1 month to 22.3 years (median 7.9 years) after PTPA. Complication associated with PTPA occurred in one recipient with portal vein thrombus (grade II); no recipients had complications over grade III in the Clavien-Dindo classification. All recipients are still alive except one dying of chronic rejection. The 10 and 20 year patient survival rates in 11 recipients were comparative to those in 268 recipients without portal complications (90% each vs 93.2% and 86.7%, p>0.1).

Conclusion

PTPA for portal vein stricture after LDLT was effective because of safety and long vascular patency.

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