Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2017; 23(46): 8227-8234
Published online Dec 14, 2017. doi: 10.3748/wjg.v23.i46.8227
Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation
Zhi-Yuan Zhang, Long Jin, Guang Chen, Tian-Hao Su, Zhi-Jun Zhu, Li-Ying Sun, Zhen-Chang Wang, Guo-Wen Xiao
Zhi-Yuan Zhang, Long Jin, Guang Chen, Tian-Hao Su, Guo-Wen Xiao, Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Zhi-Jun Zhu, Li-Ying Sun, Department of Transplantation Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Zhen-Chang Wang, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Zhang ZY and Jin L contributed equally to this work; Zhang ZY, Jin L and Wang ZC designed the research; Zhang ZY, Jin L, Chen G, Su TH, Zhu ZJ, Sun LY and Xiao GW performed the research; Zhang ZY and Jin L analyzed the data; Zhang ZY and Jin L wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Clinical Research Ethics Committee of the Affiliated Beijing Friendship Hospital of Capital Medical University.
Informed consent statement: Informed consent was not required for the study as the analysis used anonymous clinical data. Individuals cannot be identified based on the data presented.
Conflict-of-interest statement: The authors declare no conflicts of interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Long Jin, MD, PhD, Chief Doctor, Professor, Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing 100050, China. zhangzy@mail.ccmu.edu.cn.
Telephone: +86-10-63138454 Fax: +86-10-63138454
Received: October 20, 2017
Peer-review started: October 23, 2017
First decision: October 31, 2017
Revised: November 10, 2017
Accepted: November 22, 2017
Article in press: November 22, 2017
Published online: December 14, 2017
Processing time: 53 Days and 0.8 Hours
Abstract
AIM

To assess the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction (HVOO) following pediatric liver transplantation.

METHODS

A total of 246 pediatric patients underwent liver transplantation at our hospital between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Seven procedures (two patients underwent two balloon dilatation procedures) were included in this analysis. The demographic data, types of donor and liver transplant, interventional examination and therapeutic outcomes of these five children were analyzed. The median interval time between pediatric liver transplantation and balloon dilatation procedures was 9.8 mo (range: 1-32).

RESULTS

Five children with HVOO were successfully treated by balloon angioplasty without stent placement, with seven procedures performed for six stenotic lesions. All children underwent successful percutaneous intervention. Among these five patients, four were treated by single balloon angioplasty, and these patients did not develop recurrent stenosis. In seven episodes of balloon angioplasty across the stenosis, the pressure gradient was 12.0 ± 8.8 mmHg before balloon dilatation and 1.1 ± 1.5 mmHg after the procedures, which revealed a statistically significant reduction (P < 0.05). The overall technical success rate among these seven procedures was 100% (7/7), and clinical success was achieved in all five patients (100%). The patients were followed for 4-33 mo (median: 15 mo). No significant procedural complications or procedure-related deaths occurred.

CONCLUSION

Balloon dilatation is an effective and safe therapeutic option for HVOO in children undergoing pediatric liver transplantation. Venous angioplasty is also recommended in cases with recurrent HVOO.

Keywords: Hepatic venous outflow obstruction; Pediatric liver transplantation; Percutaneous transluminal balloon dilatation; Pressure gradient; Recurrent

Core tip: Hepatic venous outflow obstruction (HVOO) is a rare and severe complication following pediatric liver transplantation that leads to graft loss in the majority of patients. However, it remains controversial whether stent placement or balloon angioplasty is required for patients with HVOO. This study reported our experiences with using balloon dilatation as part of the treatment for HVOO in five children subjected to pediatric liver transplantation, providing valuable information for the successful treatment of such patients. Balloon dilatation is an effective and safe treatment for HVOO in pediatric patients following liver transplantation, and re-venoplasty is recommended even for patients with recurrent HVOO.