Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
Liver Transpl. 2023 Dec 1;29(12):1292-1303. doi: 10.1097/LVT.0000000000000234. Epub 2023 Aug 7.
Hepatic venous outflow obstruction (HVOO) is a rare but critical vascular complication after adult living donor liver transplantation. We categorized HVOOs according to their morphology (anastomotic stenosis, kinking, and intrahepatic stenosis) and onset (early-onset < 3 mo vs. late-onset ≥ 3 mo). Overall, 16/324 (4.9%) patients developed HVOO between 2000 and 2020. Fifteen patients underwent interventional radiology. Of the 16 hepatic venous anastomoses within these 15 patients, 12 were anastomotic stenosis, 2 were kinking, and 2 were intrahepatic stenoses. All of the kinking and intrahepatic stenoses required stent placement, but most of the anastomotic stenoses (11/12, 92%) were successfully managed with balloon angioplasty, which avoided stent placement. Graft survival tended to be worse for patients with late-onset HVOO than early-onset HVOO (40% vs. 69.3% at 5 y, p = 0.162) despite successful interventional radiology. In conclusion, repeat balloon angioplasty can be considered for simple anastomotic stenosis, but stent placement is recommended for kinking or intrahepatic stenosis. Close follow-up is recommended in patients with late-onset HVOO even after successful treatment.
肝静脉流出道梗阻 (HVOO) 是成人活体供肝移植后罕见但严重的血管并发症。我们根据 HVOO 的形态（吻合口狭窄、扭曲和肝内狭窄）和发病时间（早发 < 3 个月与晚发≥3 个月）对其进行分类。2000 年至 2020 年间，共有 324 例患者中 16 例（4.9%）发生 HVOO。15 例患者接受了介入放射治疗。在这 15 例患者的 16 个肝静脉吻合口中，12 个为吻合口狭窄，2 个为扭曲，2 个为肝内狭窄。所有的扭曲和肝内狭窄都需要支架置入，但大多数吻合口狭窄（11/12，92%）通过球囊血管成形术成功治疗，避免了支架置入。尽管介入放射治疗成功，但与早发 HVOO 相比，晚发 HVOO 患者的移植物存活率较差（5 年时分别为 40%和 69.3%，p=0.162）。总之，对于单纯吻合口狭窄，可以考虑重复球囊血管成形术，但对于扭曲或肝内狭窄，建议支架置入。即使在成功治疗后，也应密切随访晚发 HVOO 患者。
