Stenting for Inferior Vena Cava Stenosis After Liver Transplant

Abstract

OBJECTIVE. A case series analysis and meta-analysis were performed to assess the efficacy of stenting for inferior vena cava (IVC) stenosis after liver transplant; a secondary analysis assessed demographic factors as potential predictors of all-cause mortality. MATERIALS AND METHODS. Liver transplant recipients treated for symptomatic IVC stenosis at a major medical center from 1996 to 2017 were assessed. The main medical databases were searched for studies evaluating stenting in liver transplant recipients with IVC stenosis. Cox proportional hazards regression analysis was used to determine predictors of survival (age, sex, reason for transplant, stent size and number, publication year). Univariate and multivariable models were constructed. Because patients in the case series and meta-analysis had similar demographics and outcomes, the results were pooled. RESULTS. The case series included 40 patients (31 treated with stents; nine, without stents). Meta-analysis of 5277 records identified 17 eligible studies involving 73 patients. Stenting was effective in resolving the gradient in 100% of patients and in relieving symptoms in 85% of patients. Primary stent patency at latest follow-up (median, 556 days) was seen in 113 of 118 stents (96%; some patients had multiple stents). Reason for transplant was the only significant predictor of all-cause mortality; patients with hepatocellular carcinoma had a higher hazard of death than those undergoing transplant for other reasons (hazard ratio = 3.23; 95% CI, 1.40-7.42; p = 0.006). CONCLUSION. Stenting for IVC stenosis after liver transplant is clinically effective and durable, with 96% of stents showing long-term patency and 85% of patients experiencing symptom relief.

Keywords: hepatocellular carcinoma; inferior vena cava stenosis; liver transplant; stenting; transplant complications.