Hepatic venous outflow obstruction following living donor liver traansplantation

AIM: Hepatic venous outflow stenosis (HVOS) is one of the major complication after living donor liver transplantation (LDLT). Various venous reconstruction models have been developed to minimize HVOS risk. Despite technical advances, the mess when and how HVOS cases should be approached, is still going on.In this study, we aimed to share our approach to patients who developed HVOSafter LDLT. MATERIAL AND METHOD: Between November 2007 and April 2014, 1011 patients who have been performed LDLT, were analyzed retrospectively at Inonu University Medical Faculty, Department of General Surgery. Demographic, clinical and radiographic data of the 35 patients who developed post-transplant HVOS, were retrospectively evaluated.By considering the underlying cause of venous stenosis, stenosis was defined as early HVOS in the first 30 days and occurring after 30 days post-transplant was defined as the late period. In the diagnosis of HVOSwas used liver function tests, Doppler ultrasonography and dynamic computed tomography.In addition, both diagnosis and necessary interventional treatment of HVOS was performed with venography. FINDINGS: Total35 (3.46%) patients who were ages range from 1 to 61 years (32.5 ± 20.3 years), 22 males and 13 females were included in the study.The number of adult age group patients was 24[age: 18-61 (44.1) years, MELD Score: 8-50 (19.3) GWRW: 1.1% (0.8-1.9%)] and 11 was pediatric [age: 1-17 (8.0) year, PELD Score: 2-41 (22.4) GWRW: 1.6% (0.78-3%)]. The period that was developed symptoms consistent with the HVOS was an average 205.7 ± 264 days (range 14-1440 days) after transplantation. The number of patients who developed HVOSin the post-transplant late period (> 30 days) was 27, and 8 patients was in the early post-transplant period (≤30 days). Balloon angioplasty was performed a mean of 1.5 ± 1.1 (range: 1-6) times for each patient. In 4 patients (2 adults, 2 pediatric),expandable stents were placed in the same session with balloon angioplasty. In 51-2310day follow-up period after angioplasty, 24 (68.6%) patients who had symptoms related HVOS completely regressed , 11 (31.4%) patients did not improve.9 of the patients who did not improve the clinical status, diedwith graft failure, and 2 of them died after retransplantation. In short of, mortality in the patients who developed HVOS in the late period, was 22.2% and mortality in the patients who developed HVOS in early period was 62.5%. CONCLUSION: After LDLT, our HVOS rate (3.46%) is lower than the rate reported in the literature.The reason why such a small amount is observed in our cases, we used venous anastomosis model that had been with a broad rim during transplantation. In the management of patients who developed HVOS, the priority should be given to angiographic diagnostic tools. Key words; Liver transplantation, venous reconstruction, hepatic venous outflow obstruction;,ballon angioplasty