The value of primary vascular stents in management of early portal vein stenosis after liver transplantation

Abstract

If portal vein stenosis (PVS) occurs within 1 month after liver transplantation (LT), especially within 1 week, it can be catastrophic and result in rapid loss of the grafts and mortality. Although surgical treatments have been considered standard treatment for PVS, patients are usually unable to receive operations or re-transplantations, because of their critical conditions and a shortage of grafts. Recently, primary percutaneous transhepatic portal vein stents (PTPS) were suggested as alternative and less-invasive treatments of PVS. However, because lethal complications may follow these primary stent placements for patients in early stages after LT, primary PTPS placements for patients suffering PVS 1 month after LT has been suggested. From November 2009 to July 2015, 38 consecutive adult patients underwent LT at our institution. Among them, six recipients suffered PVS within 1 month after LT. Technical success was achieved in all six patients. Clinical success was obtained in two of the four patients suffering PVS within 1 week after LT, and in the other two patients suffering PVS>1 week after LT. All surviving patients and their grafts were in good condition, and their stents remained patent. Our experience showed that primary PTPS placements can be used to effectively treat patients with PVS encountered within 1 month, and even within 1 week, after LT with acceptable short-term results. However, possible fatal complications should be kept in mind. Long-term results of these procedures need further follow-up.

Keywords: Doppler ultrasound; Liver transplantation; Percutaneous transhepatic portal vein stent; Portal vein stenosis; Portography.

Figure 1

A 61‐year‐old male patient showed main portal vein stenosis 2 days after liver transplantation. (A) Stricture of anastomosis of portal vein (arrow) and apparent collateral circulations (arrowhead) of portal vein shown by CTA. Although CTA showed that there was post‐stenotic contrast enhancement of this liver graft, this patient suffered progressive deteriorating liver function (aspartate transaminase of 2238 IU/L, alanine transaminase of 1402 IU/L, prothrombin time international normalized ratio of 2.64) due to insufficient portal flow. Therefore, urgent PTPS was performed on this patient to rescue his liver graft. (B) Transhepatic portal venogram showed a high‐grade stenosis (arrow) at the anastomosis of the portal vein. The evident coronary vein was also observed (arrowhead). (C) A Wallstent (12 mm × 60 mm; arrow) was placed to bypass the stenotic portion of the anastomotic portal vein, and a follow‐up portography was performed 1 week later. The portography showed no further anastomotic stenosis of the portal vein and disappearance of engorged collateral circulation of the portal system. (D) The follow‐up abdominal CTA also showed that the metallic stent (arrow) in the portal vein of the liver graft was patent and in adequate position 35 months after his liver transplantation. CTA = computed tomography angiography; PTPS = percutaneous transhepatic portal vein stents.