The İncidence of Hepatic Vein Obstruction After Living Donor Liver Transplantation and Management: A Single Center Experience

Abstract

Introduction: Vascular complications after living donor liver transplantation (LDLT) might result in significant postoperative complications. The aim of this study is to determine the factors associated with the incidence of hepatic venous outflow obstruction (HVOO) and to analyze management modalities. 
Material and Methods: Clinical data of 512 patients who underwent LDLT from October 1988 to December 2015 at Baskent University hospital were identified. 
Results: Eleven of 382 transplants were identified to have HVOO of whom 10 were males and 9 were females. The hepatic vein(HV) was anastomosed to the inferior vena cava in 5 patients, and HV to HV confluence in 14 patients. Ascites was the most common post operative manifestation of HVOO. Evidence of HVOO were revealed in 15 patients in the early period (within the first 30 postoperative days), and in 4 patients at late period (after postoperative day 30). We performed balloon dilatation in all 19 patients, and 5 patients had balloon dilatation more than two. A stent was inserted after balloon dilatation in 5 patients. Embolism of pulmonary artery was seen in 1 patient as a complication resulting from insertition of the stent.
Conclusion: Although Doppler USG was useful in identifying the venous outflow obstruction, the exact site of obstruction was determined with venography which was also used in therapeutic dilatation. Technical steps to avoid HVOO include keeping the HV to caval anastomosis short and wide with triangulation, and to avoid graft rotation at the hepato caval junction.

Keywords

• stent balon,dilatasyon,hepatik ven

Canlı Vericiden Karaciğer Transplantasyonu Sonrasında Hepatik Ven Obstruksiyonu Sıklığı ve Yönetimi: Tek Merkez Deneyimi

Abstract

Giriş: Canlı vericiden karaciğer nakli sonrası vaskülar komplikasyonlar ameliyat sonrası önemli problemlere neden olabilir. Neyse ki bu vasküler komplikasyonlar yeni bir ameliyat gerektirmeden girişimsel teknikler ile tedavi edilebilmektedir. Bu çalışmada hepatik ven obstruksiyonun sıklığı ve tedavi yöntemlerini analiz etmeyi amaçladık. 
Materyal ve Metod: Kasım 1988 –Aralık 2015 yılları arasında başkent üniversitesi tıp fakültesi Ankara hastanesinde toplam 496 hastaya 512 karaciğer nakli yapıldı. Hastalar retrospektif olarak incelendi. Toplam 382 hasta çalışmaya dahil edildi.. 
Bulgular: Doppler usg ile hepatik ven obstruksiyonu desteklenmesine rağmen venografi hem tanıyı doğrulaması hemde bir tedavi yöntemi olması nedeniyle daha üstündü. Venografi sonrası 19(%100) hastanın hepsine dilatasyon yapıldı. Bu hastalardan 12’sine 2 seans, 5 tanesine 3 seans 2 tanesine 4 saeans balon dilatasyon yapıldı. Balon dilatasyon sonrası tedaviye cevap vermeyen 5 hastaya girişimsel radyoloji tarafından metalik stent yerleştirildi. 14 (%73) hasta dilatasyon yeterli olurken, 5(%27) hasta stent ile tedavi edildi. 
Tartışma: HVO tedavisinde radyolojik teknikler tekrarlanır olabilmesi, komplikasyon oranının düşük olması ve gerekirse eş zamanlı stent yerleştirilebilmesi acısından avantajlıdır.

Keywords

• stent,balloon dilatation,hepatic vein

References

1. Referans1 Kelly DA, Mayer D. Liver transplantation. In: Kelly DA (ed) Diseases of liver and biliary system in children, 2nd edn. Wiley-Blackwell, Oxford. 2003. pp 378–401.
2. Referans2 Sieders E, Peeters PM, TenVergert EM, de Jong KP, Porte RJ, Zwaveling JH, Bijleveld CM, Slooff MJ. Early vascular complications after pediatric liver transplantation. Liver Transpl. 2000 May;6(3):326-32.
3. Referans3 Settmacher U, Nüssler NC, Glanemann M, Haase R, Heise M, Bechstein WO, Neuhaus P. Venous complications after orthotopic liver transplantation. Clin Transplant. 2000 Jun;14(3):235-41.
4. Referans4 Viteri-Ramírez G, Alonso-Burgos A, Simon-Yarza I, Rotellar F, Herrero JI, Bilbao JI. Hepatic venous outflow obstruction after transplantation: outcomes for treatment with selfexpanding stents. Radiologia. 2015 Jan-Feb;57(1):56-65.
5. Referans5 Huang TL, Chen TY, Tsang LL, Sun PL, Chen YS, Wang CC, Wang SH, Lin TS, Chiang YC, Chiu KW, Eng HL, Jawan B, Cheng YF, Chen CL. Hepatic venous stenosis in partial liver graft transplantation detected by color Doppler ultrasound before and after radiological interventional management. Transplant Proc. 2004 Oct;36(8):2342-3.