活体供肝移植术后流出道梗阻患者支架置入的长期结果

Long-Term Results of Stent Placement in Patients with Outflow Block After Living-Donor-Liver Transplantation.

作者信息

Fujimori Masashi, Yamakado Koichiro, Takaki Haruyuki, Nakatsuka Atsuhiro, Uraki Junji, Yamanaka Takashi, Hasegawa Takaaki, Sugino Yuichi, Nakajima Ken, Matsushita Naritaka, Mizuno Shugo, Sakuma Hajime, Isaji Shuji

机构信息

Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.

出版信息

Cardiovasc Intervent Radiol. 2016 Apr;39(4):566-74. doi: 10.1007/s00270-015-1210-4. Epub 2015 Oct 14.

DOI:10.1007/s00270-015-1210-4

PMID:26464222

Abstract

PURPOSE

To evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT).

MATERIALS AND METHODS

For this institutional review board approved retrospective study conducted during 2002-2012, stents were placed in outflow veins in 15 patients (11.3%, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4-69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complications were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT.

RESULTS

Stents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100%, 15/15). Clinical manifestations improved in 11 patients (73.3%, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7%, 4/15) who died in the hospital 1.0-3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2%, p = .405).

CONCLUSION

Stenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.

摘要

目的

回顾性评估活体肝移植（LDLT）术后出现流出道梗阻患者支架置入的长期效果。

材料与方法

在本机构审查委员会批准的2002年至2012年进行的回顾性研究中，15例（11.3%，15/133）LDLT术后出现流出道梗阻的患者（12例男性；3例女性）接受了流出静脉支架置入。他们的平均年龄为52.3岁±15.3（标准差）（范围4 - 69岁）。7例患者下腔静脉、7例患者肝静脉以及1例患者两者均出现压力梯度≥5 mmHg的静脉狭窄（流出道梗阻）。评估技术成功率、压力梯度变化、临床表现及并发症。将15例接受流出道梗阻支架置入患者的总生存率与116例LDLT术后无流出道梗阻患者的总生存率进行比较。

结果

支架成功置入流出道梗阻静脉，无并发症发生，所有患者（100%，15/15）的压力梯度降至≤3 mmHg。11例患者（73.3%，11/15）的临床表现改善，全部出院。然而，其他4例患者（26.7%，4/15）的临床表现未改善，在支架置入后1.0 - 3.7个月（平均2.0±1.2个月）死于医院。LDLT术后有流出道梗阻和无流出道梗阻患者的5年生存率无显著差异（61.1%对72.2%，p = 0.405）。