Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience

Objectives: In this study, we share our approach for care of patients with hepatic venous outlet obstruction after living-donor liver transplant.Materials and Methods: We retrospectively examined the demographic, clinical, and radiologic data of 35 patients who developed hepatic venous outlet obstruction after living-donor liver transplant. Patients were subgrouped on the basis of onset (8 patients with early onset [< 30 days post-transplant] and 27 patients with late onset [>= 30 days posttransplant]) and postoperative survival (24 survivors, 11 nonsurvivors).Results: Patients ranged in age from 1 to 61 years (24 adults and 11 children). All adult patients had undergone right lobe living-donor liver transplant. In the pediatric group, 8 had undergone left lateral segment and 3 had undergone left lobe living-donor liver transplant. Nineteen adult patients and all 11 pediatric patients underwent hepatic venous reconstruction, with all procedures based on common large-opening drainage models using various vascular graft materials. Development of hepatic venous outlet obstruction occurred at mean posttransplant day 233 +/- 298.5 in the adult patients and mean posttransplant day 139 +/- 97.8 in the pediatric patients. After development of obstruction, the patients underwent 1-6 sessions (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 late-onset subgroups showed statistically significant differences in serum albumin (P=.01), underlying causes (P<.001), time from transplant to obstruction (P=.02), and time from transplant to last visit (P=.02). The survivor and nonsurvivor subgroups showed statistically significant differences in total bilirubin (P=.03) and time from transplant to last visit (P=.03).Conclusions: Common large-opening reconstruction minimizes hepatic venous outlet obstruction development after living-donor liver transplant. Balloon angioplasty and/or stenting is almost always the first option in the care of this complication.