Pediatric Radiology

, Volume 48, Issue 5, pp 667–679 | Cite as

Diagnosis, treatment and outcome of hepatic venous outflow obstruction in paediatric liver transplantation: 24-year experience at a single centre

  • Alexis Galloux
  • Erika Pace
  • Stephanie Franchi-Abella
  • Sophie Branchereau
  • Emmanuel Gonzales
  • Daniele Pariente
Original Article
  • 94 Downloads

Abstract

Background

Hepatic venous outflow obstruction after paediatric liver transplantation is an unusual but critical complication.

Objectives

To review the incidence, diagnosis and therapeutic modalities of hepatic venous outflow obstruction from a large national liver transplant unit.

Materials and methods

During the period from October 1992 to March 2016, 917 liver transplant procedures were performed with all types of grafts in 792 children. Transplants suspected to have early or delayed venous outflow obstruction were confirmed by percutaneous venography or surgical revision findings. Therapeutic intervention, recurrence and outcome were evaluated.

Results

Twenty-six of 792 children (3.3%) experienced post-transplant hepatic venous outflow obstruction. These patients had been diagnosed from 1 day to 8.75 years after transplantation. Six occurred during the early post-transplant period; in three of them, the graft was lost. Seventeen patients were initially treated by balloon angioplasty with success; 11 of these experienced recurrences. Four stents were implanted; one was complicated by definitive occlusion. Three of the five surgical revisions were successful. The initial stenosis involved the inferior vena cava in 10 grafts, in isolation or associated with hepatic vein involvement. Mean follow-up was 79 months after transplantation. Eight grafts were lost.

Conclusion

Acute postoperative hepatic venous outflow obstruction was associated with poor prognosis. Diagnostic venography should be performed if there is any suspicion of venous outflow obstruction, even if first-line examinations are normal. Stenosis frequently involved the inferior vena cava. Angioplasty was a safe and efficient treatment for venous outflow obstruction despite frequent recurrence.

Keywords

Budd-Chiari syndrome Computed tomography Children Hepatic venous outflow obstruction Liver transplantation Ultrasound Vascular complications Venography Venous angioplasty 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Goss JA, Shackleton CR, McDiarmid SV et al (1998) Long-term results of pediatric liver transplantation: an analysis of 569 transplants. Ann Surg 228:411–420CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Tanaka K, Uemoto S, Tokunaga Y et al (1993) Surgical techniques and innovations in living related liver transplantation. Ann Surg 217:82–91CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sieders E, Peeters PM, TenVergert EM et al (2000) Early vascular complications after pediatric liver transplantation. Liver Transpl 6:326–332CrossRefPubMedGoogle Scholar
  4. 4.
    Emond JC, Heffron TG, Kortz EO et al (1993) Improved results of living-related liver transplantation with routine application in a pediatric program. Transplantation 55:835–840CrossRefPubMedGoogle Scholar
  5. 5.
    Kilic M, Aydinli B, Aydin U et al (2008) A new surgical technique for hepatic vein reconstruction in pediatric live donor liver transplantation. Pediatr Transplant 12:677–681CrossRefPubMedGoogle Scholar
  6. 6.
    Buell JF, Funaki B, Cronin DC et al (2002) Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg 236:658–666CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Emond JC, Heffron TG, Whitington PF, Broelsch CE (1993) Reconstruction of the hepatic vein in reduced size hepatic transplantation. Surg Gynecol Obstet 176:11–17PubMedGoogle Scholar
  8. 8.
    Darcy MD (2007) Management of venous outflow complications after liver transplantation. Tech Vasc Interv Radiol 10:240–245CrossRefPubMedGoogle Scholar
  9. 9.
    Egawa H, Tanaka K, Uemoto S et al (1993) Relief of hepatic vein stenosis by balloon angioplasty after living-related donor liver transplantation. Clin Transpl 7:306–311Google Scholar
  10. 10.
    Kubo T, Shibata T, Itoh K et al (2006) Outcome of percutaneous transhepatic venoplasty for hepatic venous outflow obstruction after living donor liver transplantation. Radiology 239:285–290CrossRefPubMedGoogle Scholar
  11. 11.
    Mazariegos GV, Garrido V, Jaskowski-Phillips S et al (2000) Management of hepatic venous obstruction after split-liver transplantation. Pediatr Transplant 4:322–327CrossRefPubMedGoogle Scholar
  12. 12.
    Sommovilla J, Doyle MM, Vachharajani N et al (2014) Hepatic venous outflow obstruction in pediatric liver transplantation: technical considerations in prevention, diagnosis, and management. Pediatr Transplant 18:497–502CrossRefPubMedGoogle Scholar
  13. 13.
    Lorenz JM, Van Ha T, Funaki B et al (2006) Percutaneous treatment of venous outflow obstruction in pediatric liver transplants. J Vasc Interv Radiol 17:1753–1761CrossRefPubMedGoogle Scholar
  14. 14.
    Sakamoto S, Egawa H, Kanazawa H et al (2010) Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto University experience. Liver Transpl 16:1207–1214CrossRefPubMedGoogle Scholar
  15. 15.
    Yabuta M, Shibata T, Shibata T et al (2013) Long-term outcome of percutaneous interventions for hepatic venous outflow obstruction after pediatric living donor liver transplantation: experience from a single institute. J Vasc Interv Radiol 24:1673–1681CrossRefPubMedGoogle Scholar
  16. 16.
    Fujimoto M, Moriyasu F, Someda H et al (1995) Recovery of graft circulation following percutaneous transluminal angioplasty for stenotic venous complications in pediatric liver transplantation: assessment with Doppler ultrasound. Transpl Int 8:119–125CrossRefPubMedGoogle Scholar
  17. 17.
    Kim KW, Kim TK, Kim SY et al (2007) Doppler sonographic abnormalities suggestive of venous congestion in the right lobe graft of living donor liver transplant recipients. AJR Am J Roentgenol 188:W239–W245CrossRefPubMedGoogle Scholar
  18. 18.
    Hwang HJ, Kim KW, Jeong WK et al (2009) Hepatic outflow obstruction at middle hepatic vein tributaries or inferior right hepatic veins after living donor liver transplantation with modified right lobe graft: comparison of CT and Doppler ultrasound. AJR Am J Roentgenol 193:745–751CrossRefPubMedGoogle Scholar
  19. 19.
    Ametani F, Itoh K, Shibata T et al (2001) Spectrum of CT findings in pediatric patients after partial liver transplantation. Radiographics 21:53–63CrossRefPubMedGoogle Scholar
  20. 20.
    Raby N, Karani J, Thomas S et al (1991) Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty. AJR Am J Roentgenol 157:167–171CrossRefPubMedGoogle Scholar
  21. 21.
    Cheng YF, Chen CL, Huang TL et al (2005) Angioplasty treatment of hepatic vein stenosis in pediatric liver transplants: long-term results. Transpl Int 18:556–561CrossRefPubMedGoogle Scholar
  22. 22.
    Gibelli NE, Tannuri AC, Andrade WC et al (2012) Centrilobular necrosis as a manifestation of venous outflow block in pediatric malnourished liver transplant recipients—case reports. Pediatr Transplant 16:E383–E387CrossRefPubMedGoogle Scholar
  23. 23.
    Akamatsu N, Sugawara Y, Kaneko J et al (2004) Surgical repair for late-onset hepatic venous outflow block after living-donor liver transplantation. Transplantation 77:1768–1770CrossRefPubMedGoogle Scholar
  24. 24.
    Sakamoto S, Nakazawa A, Shigeta T et al (2013) Devastating outflow obstruction after pediatric split liver transplantation. Pediatr Transplant 17:E25–E28CrossRefPubMedGoogle Scholar
  25. 25.
    Mehrabi A, Mood ZA, Fonouni H et al (2009) A single-center experience of 500 liver transplants using the modified piggyback technique by Belghiti. Liver Transpl 15:466–474CrossRefPubMedGoogle Scholar
  26. 26.
    Heffron TG, Pillen T, Smallwood G et al (2010) Incidence, impact, and treatment of portal and hepatic venous complications following pediatric liver transplantation: a single-center 12 year experience. Pediatr Transplant 14:722–729CrossRefPubMedGoogle Scholar
  27. 27.
    Krishna Kumar G, Sharif K, Mayer D et al (2010) Hepatic venous outflow obstruction in paediatric liver transplantation. Pediatr Surg Int 26:423–425CrossRefPubMedGoogle Scholar
  28. 28.
    Parrilla P, Sánchez-Bueno F, Figueras J et al (1999) Analysis of the complications of the piggy-back technique in 1,112 liver transplants. Transplantation 67:1214–1217CrossRefPubMedGoogle Scholar
  29. 29.
    Choi JW, Jae HJ, Kim H-C et al (2015) Long-term outcome of endovascular intervention in hepatic venous outflow obstruction following pediatric liver transplantation. Liver Transpl 21:1219–1226CrossRefPubMedGoogle Scholar
  30. 30.
    Sakamoto S, Ogura Y, Shibata T et al (2009) Successful stent placement for hepatic venous outflow obstruction in pediatric living donor liver transplantation, including a case series review. Pediatr Transplant 13:507–511CrossRefPubMedGoogle Scholar
  31. 31.
    Ko G-Y, Sung K-B, Yoon H-K et al (2002) Endovascular treatment of hepatic venous outflow obstruction after living-donor liver transplantation. J Vasc Interv Radiol 13:591–599CrossRefPubMedGoogle Scholar
  32. 32.
    Umehara M, Narumi S, Sugai M et al (2012) Hepatic venous outflow obstruction in living donor liver transplantation: balloon angioplasty or stent placement? Transplant Proc 44:769–771CrossRefPubMedGoogle Scholar
  33. 33.
    Carnevale FC, Machado AT, Moreira AM et al (2008) Midterm and long-term results of percutaneous endovascular treatment of venous outflow obstruction after pediatric liver transplantation. J Vasc Interv Radiol 19:1439–1448CrossRefPubMedGoogle Scholar
  34. 34.
    Ko G-Y, Sung K-B, Yoon H-K et al (2008) Early posttransplant hepatic venous outflow obstruction: long-term efficacy of primary stent placement. Liver Transpl 14:1505–1511CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alexis Galloux
    • 1
  • Erika Pace
    • 1
  • Stephanie Franchi-Abella
    • 1
  • Sophie Branchereau
    • 2
    • 3
  • Emmanuel Gonzales
    • 2
    • 4
  • Daniele Pariente
    • 1
  1. 1.AP-HP, Bicêtre Hospital, Pediatric Radiology DepartmentLe Kremlin BicêtreFrance
  2. 2.Faculty of MedicineParis Sud UniversityLe Kremlin BicêtreFrance
  3. 3.AP-HP, Bicêtre Hospital, Pediatric Surgery DepartmentLe Kremlin BicêtreFrance
  4. 4.AP-HP, Bicêtre Hospital, Pediatric Hepatology DepartmentLe Kremlin BicêtreFrance

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