Masashi Fujimori1, Koichiro Yamakado2, Haruyuki Takaki3, Atsuhiro Nakatsuka4, Junji Uraki5, Takashi Yamanaka6, Takaaki Hasegawa7, Yuichi Sugino8, Ken Nakajima9, Naritaka Matsushita10, Shugo Mizuno11, Hajime Sakuma12, Shuji Isaji13. 1. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. fujimorim@clin.medic.mie-u.ac.jp. 2. Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. yamakado47@gmail.com. 3. Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. takaki-h@clin.medic.mie-u.ac.jp. 4. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. nakatuka@clin.medic.mie-u.ac.jp. 5. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. junji@clin.medic.mie-u.ac.jp. 6. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. t-yama@clin.medic.mie-u.ac.jp. 7. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. hasegawat@clin.medic.mie-u.ac.jp. 8. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. ysugino23@clin.medic.mie-u.ac.jp. 9. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. k-nakajima@clin.medic.mie-u.ac.jp. 10. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. n-matsushita@clin.medic.mie-u.ac.jp. 11. Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan. mizunos@clin.medic.mie-u.ac.jp. 12. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. sakuma.mie@gmail.com. 13. Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan. isaji-s@clin.medic.mie-u.ac.jp.
Abstract
PURPOSE: To evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT). MATERIALS AND METHODS: For this institutional review board approved retrospective study conducted during 2002-2012, stents were placed in outflow veins in 15 patients (11.3%, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4-69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complications were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT. RESULTS: Stents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100%, 15/15). Clinical manifestations improved in 11 patients (73.3%, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7%, 4/15) who died in the hospital 1.0-3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2%, p = .405). CONCLUSION: Stenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.
PURPOSE: To evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT). MATERIALS AND METHODS: For this institutional review board approved retrospective study conducted during 2002-2012, stents were placed in outflow veins in 15 patients (11.3%, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4-69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complications were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT. RESULTS: Stents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100%, 15/15). Clinical manifestations improved in 11 patients (73.3%, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7%, 4/15) who died in the hospital 1.0-3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2%, p = .405). CONCLUSION: Stenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.
Authors: Jan-Paul Gundlach; Rainer Günther; Marcus Both; Jens Trentmann; Jost Philipp Schäfer; Jochen T Cremer; Christoph Röcken; Thomas Becker; Felix Braun; Alexander Bernsmeier Journal: Ann Transplant Date: 2020-08-04 Impact factor: 1.530