Long-term follow-up after endovascular treatment of hepatic venous outflow obstruction following liver transplantation

Hepatic venous outflow obstruction (HVOO) is a rare complication after liver transplantation (LT) associated with significant morbidity and reduced graft survival. Endovascular intervention has become the first line treatment for HVOO, but data on long-term outcomes is lacking. We have analysed outcomes after endovascular intervention for HVOO in 905 consecutive patients who received 965 full-size LT at our unit from January 2007 to June 2014. There were 27 (3%) patients who underwent hepatic venogram for suspected HVOO, with persistent ascites being the most common symptom triggering the investigation (n=19, 70%). Of those, only 10 patients demonstrated either stricture or pressure gradient over 10 mmHg on venogram, which represents a 1% incidence of HVOO. The endovascular interventions were balloon dilatation (n=3), hepatic vein stenting (n=4) and stenting with dilatation (n=3). Two patients required re-stenting due to stent migration. The symptoms of HVOO completely resolved in all but one patient, with a median follow up period of 74 (inter quartile range 39 - 89) months. There were no procedure related complications or mortality. In conclusion, the incidence of HVOO in patients receiving full-size LT is currently very low. Endovascular intervention is an effective and safe procedure providing symptom relief with long-lasting primary patency. This article is protected by copyright. All rights reserved.