Document Detail


Management of venous stenosis in living donor liver transplant recipients.
MedLine Citation:
PMID:  19842231     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation (LDLT).
METHODS: From February 1999 to May 2009, 1 intraoperative hepatic vein (HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT recipients. Postoperative portal vein (PV) anastomotic stenosis occurred in 1 pediatric left lobe LDLT. Patients ranged in age from 9 to 56 years (median, 44 years). An air balloon was used to correct the intraoperative HV tension. Emergent surgical reoperation, transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3, 15, 50, 55, and 270 after LDLT, respectively. Balloon dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after LDLT.
RESULTS: The intraoperative HV tension was corrected with an air balloon. The recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d later. HV balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all patients. The patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared, while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk later. Two patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites, respectively. Balloon dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT, and this patient has survived for 9 mo without recurrent PV stenosis and ascites.
CONCLUSION: Intraoperative balloon placement, emergent reoperation, proper interventional balloon dilatation and stent placement can be effective as a way to manage hepatic and PV stenosis during and after LDLT.
Authors:
Jie Yang; Ming-Qing Xu; Lu-Nan Yan; Wu-Sheng Lu; Xiao Li; Zheng-Rong Shi; Bo Li; Tian-Fu Wen; Wen-Tao Wang; Jia-Ying Yang
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of gastroenterology : WJG     Volume:  15     ISSN:  2219-2840     ISO Abbreviation:  World J. Gastroenterol.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-20     Completed Date:  2010-01-07     Revised Date:  2014-05-20    
Medline Journal Info:
Nlm Unique ID:  100883448     Medline TA:  World J Gastroenterol     Country:  China    
Other Details:
Languages:  eng     Pagination:  4969-73     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anastomosis, Surgical
Catheterization* / instrumentation
Child
Constriction, Pathologic
Graft Occlusion, Vascular / etiology,  mortality,  therapy*
Graft Rejection / etiology,  prevention & control
Hepatic Veins / surgery*
Humans
Liver Transplantation / adverse effects*,  mortality
Living Donors*
Male
Middle Aged
Portal Vein / surgery*
Renal Insufficiency / etiology
Reoperation
Retrospective Studies
Stents
Time Factors
Treatment Outcome
Vascular Surgical Procedures / adverse effects*,  mortality
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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