Published online Dec 14, 2017. doi: 10.3748/wjg.v23.i46.8227
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
Liver transplantation is the most effective treatment for end-stage liver disease. Hepatic venous outflow obstruction (HVOO) is a severe complication of pediatric liver transplantation, which has a high incidence of 4%-9% owing to the smaller anastomosis diameter and size mismatch of the hepatic vessels between the donor and recipient. Endovascular angioplasty is a less-invasive therapeutic option that has become the first-line treatment option in pediatric transplant recipients. However, it remains controversial whether stent placement or balloon angioplasty is required for patients with HVOO. Rare cases of HVOO have been reported in pediatric patients following liver transplantation. 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 data for the successful treatment of such patients.
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.
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.
The authors enrolled a total of 246 pediatric patients who underwent liver transplantation between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Percutaneous interventions were performed under general anesthesia in all patients (n = 5). The demographic data, types of donor and liver transplant, interventional examination and therapeutic outcomes of these five children were collected and analyzed with SPSS version 21.0 software. Changes between pre- and post-procedural pressure gradients across the hepatic vein stenosis were analyzed by paired Student’s t-test.
The authors found that balloon dilatation is an effective and safe treatment for HVOO in pediatric patients following liver transplantation. The hepatic vein stenosis rate was 1.62%. The time to onset of hepatic vein stenosis ranged from 1-32 mo (mean: 9.80 mo) after liver transplantation. The pressure gradient across the stenotic lesions at the anastomoses before balloon dilatation decreased significantly after the procedure (P < 0.05). Sustained follow-up did not reveal significant procedural complications or procedure-related deaths. Further studies with a larger sample size that could identify relevant risk factors for HVOO development following transplantation and HVOO recurrence after balloon angioplasty are needed.
This study investigated the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction following pediatric liver transplantation. HVOO is a rare and severe complication following pediatric liver transplantation that leads to graft loss in the majority of patients. However, it remains unclear 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 regarding 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. In spite of the technical success and satisfactory clinical outcomes in these five children, the present study had certain limitations, including the retrospective nature of the study, a relatively small sample size, and a short follow-up period. Further studies with a large sample size that could identify risk factors for HVOO development following transplantation and HVOO recurrence after balloon angioplasty are needed.
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. In spite of the technical success and satisfactory clinical outcomes in these five children, the present study had certain limitations, including the retrospective nature of the study, a relatively small sample size, and a short follow-up period. Further studies with a large sample size that could identify risk factors for HVOO development following transplantation and HVOO recurrence after balloon angioplasty are needed.