Published online Jul 18, 2015. doi: 10.4254/wjh.v7.i14.1884
Peer-review started: March 30, 2015
First decision: April 27, 2015
Revised: June 16, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: July 18, 2015
AIM: To determine utility of transplant liver biopsy in evaluating efficacy of percutaneous transluminal angioplasty (PTA) for hepatic venous obstruction (HVOO).
METHODS: Adult liver transplant patients treated with PTA for HVOO (2003-2013) at a single institution were reviewed for pre/post-PTA imaging findings, manometry (gradient with right atrium), presence of HVOO on pre-PTA and post-PTA early and late biopsy (EB and LB, < or > 60 d after PTA), and clinical outcome, defined as good (no clinical issues, non-HVOO-related death) or poor (surgical correction, recurrent HVOO, or HVOO-related death).
RESULTS: Fifteen patients meeting inclusion criteria underwent 21 PTA, 658 ± 1293 d after transplant. In procedures with pre-PTA biopsy (n = 19), no difference was seen between pre-PTA gradient in 13/19 procedures with HVOO on biopsy and 6/19 procedures without HVOO (8 ± 2.4 mmHg vs 6.8 ± 4.3 mmHg; P = 0.35). Post-PTA, 10/21 livers had EB (29 ± 21 d) and 9/21 livers had LB (153 ± 81 d). On clinical follow-up (392 ± 773 d), HVOO on LB resulted in poor outcomes and absence of HVOO on LB resulted good outcomes. Patients with HVOO on EB (3/7 good, 4/7 poor) and no HVOO on EB (2/3 good, 1/3 poor) had mixed outcomes.
CONCLUSION: Negative liver biopsy greater than 60 d after PTA accurately identifies patients with good clinical outcomes.
Core tip: Percutaneous angioplasty and/or stent placement is the first-line of treatment in patients with hepatic venous obstruction (HVOO) after liver transplantation. Recognizing recurrence of HVOO after percutaneous treatment solely based on clinical, laboratory or imaging findings is difficult, and there is not a clear consensus regarding which measure provides the best or “gold standard” assessment for response to treatment. We report the utility of biopsy in predicting outcomes of percutaneous transluminal angioplasty (PTA) in patients with HVOO after liver transplantation. Specifically, we have found that patients without HVOO on a liver biopsy 60 d or more after PTA had no recurrence of HVOO on long-term follow-up.