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Early-onset hepatic veno-occlusive disease after liver transplantation: an institutional experience and analysis of a literature-based cohort

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Abstract

Purpose

Hepatic veno-occlusive disease (HVOD) after liver transplantation (LT) is almost always a fatal complication. We assessed the outcomes of HVOD in a single institute and analyzed a literature-based cohort.

Methods

We reviewed the medical records of recipients of LT performed between 1995 and 2020 at our institute and the literature on HVOD after LT. We then analyzed the clinical features based on a “pooled” cohort of cases identified in our institute and reported in the literature.

Results

HVOD was diagnosed in 3 of 331 LT recipients, all of whom died in hospital, on days 164, 12, and 13, respectively. Our comprehensive review of the literature, as well as our cases, identified eight cases of HVOD that developed within 14 days after LT (early-onset type). Early-onset HVOD had a significantly worse prognosis than HVOD that developed beyond 2 weeks after LT (non-early-onset type), which was identified in 22 cases (25.0% vs. 86.1% of the 3-month graft survival rate). The most common causes of early-onset and non-early-onset types were acute cellular rejection (50%) and drug-induced disease (50%), respectively.

Conclusion

Early-onset HVOD developing within 14 days after LT has a poor prognosis.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Yutaka Endo, Masahiro Shinoda, Yasushi Hasegawa, Hideaki Obara, Minoru Kitago & Yuko Kitagawa

  2. Digestive Disease Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan

    Masahiro Shinoda

  3. Department of Pathology, Keio University School of Medicine, Tokyo, Japan

    Junki Maehara & Hidenori Ojima

  4. Department of Pediatric Surgery and Transplantation, Kumamoto University School of Medicine, Kumamoto, Japan

    Taizo Hibi

  5. Department of Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences Advanced Therapeutic Sciences, Hepatobiliary and Pancreatic Surgery, Tokyo, Japan

    Minoru Tanabe

Authors
  1. Yutaka Endo
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  2. Masahiro Shinoda
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  3. Junki Maehara
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  4. Taizo Hibi
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Contributions

YE participated in patient care, conceptualization, data curation, and visualization and wrote the original article; MS participated in patient care, reviewed the article, and supervised this report; and JM and HO confirmed the pathological findings of the cases presented. TH, YH, and MT participated in patient care and reviewed the articles. MK and HO reviewed the article. YK supervised this report.

Corresponding author

Correspondence to Masahiro Shinoda.

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The author(s) declare that they have no conflict of interest.

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Written informed consent was obtained from the patients and/ or their families. This study was approved by the Ethical Committee of Keio University (No. 20130400).

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Endo, Y., Shinoda, M., Maehara, J. et al. Early-onset hepatic veno-occlusive disease after liver transplantation: an institutional experience and analysis of a literature-based cohort. Surg Today (2023). https://doi.org/10.1007/s00595-023-02770-1

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