Percutaneous transhepatic balloon dilation of portal venous stenosis in patients with living donor liver transplantation

Abstract

Purpose: To retrospectively evaluate the long-term effectiveness of percutaneous transhepatic balloon dilation of portal venous stenosis in patients who have undergone living donor liver transplantation.

Materials and methods: Institutional review board approval and informed consent were not required. From June 1996 to August 2003, obstructed portal venous blood flow was diagnosed in 45 patients (21 male, 24 female) with a history of living donor liver transplantation; patients ranged in age from 9 months to 61 years (mean, 9.2 years). All stenoses occurred in the extrahepatic portal vein near the anastomosis of the portal vein. All dilation procedures were performed with percutaneous transhepatic puncture of the intrahepatic portal vein and subsequent balloon dilation of the stenosis. Patients who experienced recurrent stenosis underwent another balloon dilation session. Intravascular metallic stents were not deployed because of the possible need for repeated transplantation. The authors used paired t tests to compare patients successfully treated with one venoplasty procedure and those requiring repeated venoplasty, with regard to age and stenosis diameter percentages before and after the initial procedure.

Results: Percutaneous balloon dilation was technically successful in 35 of 45 patients. In the remaining 10 patients, portal venous thrombotic occlusion precluded access to the mesenteric side of the portal vein. Twenty-five patients were successfully treated with a single session of balloon dilation (group 1). Results at follow-up ultrasonography revealed restenosis in 10 of 35 patients. Recurrent stenosis was resolved by means of repeated balloon dilation in nine patients (group 2). There were no significant differences between groups 1 and 2 in age (P = .87) or in stenosis diameter percentages before (P = .053) or after (P = .95) the initial procedure.

Conclusion: Percutaneous transhepatic balloon dilation seems to be an effective method for treatment of portal venous stenosis after living donor liver transplantation.