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Semin intervent Radiol 2012; 29(02): 099-104
DOI: 10.1055/s-0032-1312570
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Portal Interventions in Liver Transplant Recipients

Wael E. A. Saad
1   Division of Vascular Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
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Publication History

Publication Date:
14 June 2012 (online)

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Abstract

Portal vein interventions in liver transplant recipients represent a group of interventions in the management of several disease entities including portal vein stenosis, portal vein thrombosis, and recurrent liver cirrhosis with portal hypertension with and without gastric varices. The procedures performed in these patient populations include portal vein angioplasty with or without stent placement for portal vein stenosis, portal vein thrombolysis with or without stent placement for portal vein thrombosis, transjugular intrahepatic portosystemic shunts or splenic embolization for cirrhosis, and balloon-occluded retrograde transvenous obliteration for gastric varices. This article discusses these disease entities and the minimal invasive procedures used in their management.

Keywords

transplant - liver - vascular complications - endovascular - portal - portal hypertension - TIPS - BRTO
 

  • References

  • 1 Wozney P, Zajko AB, Bron KM, Point S, Starzl TE. Vascular complications after liver transplantation: a 5-year experience. AJR Am J Roentgenol 1986; 147 (4) 657-663
    CrossrefPubMedGoogle Scholar
  • 2 Langnas AN, Marujo W, Stratta RJ, Wood RP, Shaw Jr BW. Vascular complications after orthotopic liver transplantation. Am J Surg 1991; 161 (1) 76-82 ; discussion 82–83
    Google Scholar
  • 3 Lerut J, Tzakis AG, Bron K , et al. Complications of venous reconstruction in human orthotopic liver transplantation. Ann Surg 1987; 205 (4) 404-414
    CrossrefPubMedGoogle Scholar
  • 4 Settmacher U, Nussler NC, Glanemann M , et al. Venous complications after orthotopic liver transplantation. Clin Transpl 2000; 14: 235-241
    CrossrefPubMedGoogle Scholar
  • 5 Woo DH, Laberge JM, Gordon RL, Wilson MW, Kerlan Jr RK. Management of portal venous complications after liver transplantation. Tech Vasc Interv Radiol 2007; 10 (3) 233-239
    CrossrefPubMedGoogle Scholar
  • 6 Ueda M, Egawa H, Ogawa K , et al. Portal vein complications in the long-term course after pediatric living donor liver transplantation. Transplant Proc 2005; 37 (2) 1138-1140
    CrossrefPubMedGoogle Scholar
  • 7 Schneider N, Scanga A, Stokes L, Perri R. Portal vein stenosis: a rare yet clinically important cause of delayed-onset ascites after adult deceased donor liver transplantation: Two case reports. Transpl Proc 2011; 43: 3829-3834
    CrossrefPubMedGoogle Scholar
  • 8 Buell JF, Funaki B, Cronin DC , et al. Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg 2002; 236 (5) 658-666
    CrossrefPubMedGoogle Scholar
  • 9 Khalaf H. Vascular complications after deceased and living donor liver transplantation: a single-center experience. Transpl Proc 2010; 42: 865-870
    CrossrefPubMedGoogle Scholar
  • 10 Raby N, Karani J, Thomas S, O'Grady J, Williams R. Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty. AJR Am J Roentgenol 1991; 157 (1) 167-171
    CrossrefPubMedGoogle Scholar
  • 11 Funaki B, Rosenblum JD, Leef JA , et al. Percutaneous treatment of portal venous stenosis in children and adolescents with segmental hepatic transplants: long-term results. Radiology 2000; 215 (1) 147-151
    Google Scholar
  • 12 Funaki B, Rosenblum JD, Leef JA, Hackworth CA, Szymski GX, Alonso EM. Angioplasty treatment of portal vein stenosis in children with segmental liver transplants: mid-term results. AJR Am J Roentgenol 1997; 169 (2) 551-554
    Google Scholar
  • 13 Rollins NK, Sheffield EG, Andrews WS. Portal vein stenosis complicating liver transplantation in children: percutaneous transhepatic angioplasty. Radiology 1992; 182 (3) 731-734
    Google Scholar
  • 14 Zajko AB, Sheng R, Bron K, Reyes J, Nour B, Tzakis A. Percutaneous transluminal angioplasty of venous anastomotic stenoses complicating liver transplantation: intermediate-term results. J Vasc Interv Radiol 1994; 5 (1) 121-126
    CrossrefPubMedGoogle Scholar
  • 15 Saad WEA. Liver transplant-related vascular disease. In: Dake M, Geshwind J-F, eds. Abrams Angiography: Interventional Radiology. 2012. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins;
    Google Scholar
  • 16 Millis JM, Seaman DS, Piper JB , et al. Portal vein thrombosis and stenosis in pediatric liver transplantation. Transplantation 1996; 62 (6) 748-754
    Google Scholar
  • 17 Mantel HT, Rosen CB, Heimbach JK , et al. Vascular complications after orthotopic liver transplantation after neoadjuvant therapy for hilar cholangiocarcinoma. Liver Transpl 2007; 13 (10) 1372-1381
    CrossrefPubMedGoogle Scholar
  • 18 Cherukuri R, Haskal ZJ, Naji A, Shaked A. Percutaneous thrombolysis and stent placement for the treatment of portal vein thrombosis after liver transplantation: long-term follow-up. Transplantation 1998; 65 (8) 1124-1126
    CrossrefPubMedGoogle Scholar
  • 19 Mathias K, Bolder U, Löhlein D, Jäger H. Percutaneous transhepatic angioplasty and stent implantation for prehepatic portal vein obstruction. Cardiovasc Intervent Radiol 1993; 16 (5) 313-315
    CrossrefPubMedGoogle Scholar
  • 20 Park KB, Choo SW, Do YS, Shin SW, Cho SG, Choo IW. Percutaneous angioplasty of portal vein stenosis that complicates liver transplantation: the mid-term therapeutic results. Korean J Radiol 2005; 6 (3) 161-166
    CrossrefPubMedGoogle Scholar
  • 21 Sood D, Kumaran V, Kakodkar R , et al. Portal vein stenosis following living donor liver transplant: manifestations and management. Transpl Int 2009; 22 (4) 496-499
    CrossrefPubMedGoogle Scholar
  • 22 Wei B-J, Zhai R-Y, Wang J-F, Dai D-K, Yu P. Percutaneous portal venoplasty and stenting for anastomotic stenosis after liver transplantation. World J Gastroenterol 2009; 15 (15) 1880-1885
    CrossrefPubMedGoogle Scholar
  • 23 Saad WE, Waldman DL. Endovascular repair of vascular lesions in solid organ transplantation. In Oriel K, Katzen BT, Rosenfield K, eds. Complications in Endovascular Therapy. New York, NY: Taylor & Francis Informa; 2006: 223-252
    Google Scholar
  • 24 Saad WE, Lin E, Ormanoski M, Darcy MD, Rubens DJ. Noninvasive imaging of liver transplant complications. Tech Vasc Interv Radiol 2007; 10 (3) 191-206
    CrossrefPubMedGoogle Scholar
  • 25 Chong WK, Beland JC, Weeks SM. Sonographic evaluation of venous obstruction in liver transplants. AJR Am J Roentgenol 2007; 188: W515-W521
    CrossrefPubMedGoogle Scholar
  • 26 Quiroga S, Sebastià MC, Margarit C, Castells L, Boyé R, Alvarez-Castells A. Complications of orthotopic liver transplantation: spectrum of findings with helical CT. Radiographics 2001; 21 (5) 1085-1102
    CrossrefPubMedGoogle Scholar
  • 27 Shibata T, Itoh K, Kubo T , et al. Percutaneous transhepatic balloon dilation of portal venous stenosis in patients with living donor liver transplantation. Radiology 2005; 235 (3) 1078-1083
    CrossrefPubMedGoogle Scholar
  • 28 Duffy JP, Hong JC, Farmer DG , et al. Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J Am Coll Surg 2009; 208 (5) 896-903 ; discussion 903–905
    CrossrefPubMedGoogle Scholar
  • 29 Olcott EW, Ring EJ, Roberts JP, Ascher NL, Lake JR, Gordon RL. Percutaneous transhepatic portal vein angioplasty and stent placement after liver transplantation: early experience. J Vasc Interv Radiol 1990; 1 (1) 17-22
    CrossrefPubMedGoogle Scholar
  • 30 González-Tutor A, Abascal F, Cerezai L, Bustamante M. Transjugular approach to treat portal vein stenosis after liver transplantation—a case report. Angiology 2000; 51 (6) 511-514
    CrossrefPubMedGoogle Scholar
  • 31 Cheng YF, Ou HY, Tsang LL , et al. Interventional percutaneous trans-splenic approach in the management of portal venous occlusion after living donor liver transplantation. Liver Transpl 2009; 15 (10) 1378-1380
    CrossrefPubMedGoogle Scholar
  • 32 McDaniel HM, Johnson M, Pescovitz MD , et al. Intraoperative placement of a Wallstent for portal vein stenosis and thrombosis after liver transplantation. Transplantation 1997; 63 (4) 607-608
    PubMedGoogle Scholar
  • 33 Ko GY, Sung KB, Yoon HK, Lee S. Early posttransplantation portal vein stenosis following living donor liver transplantation: percutaneous transhepatic primary stent placement. Liver Transpl 2007; 13 (4) 530-536
    CrossrefPubMedGoogle Scholar
  • 34 Baccarani U, Gasparini D, Risaliti A , et al. Percutaneous mechanical fragmentation and stent placement for the treatment of early post-transplantation portal vein thrombosis. Transplantation 2001; 15: 1572-1582
    PubMedGoogle Scholar
  • 35 Durham JD, LaBerge JM, Altman S , et al. Portal vein thrombolysis and closure of competitive shunts following liver transplantation. J Vasc Interv Radiol 1994; 5 (4) 611-615 , discussion 616–618
    CrossrefPubMedGoogle Scholar
  • 36 Glockner JF, Forauer AR. Vascular or ischemic complications after liver transplantation. AJR Am J Roentgenol 1999; 173 (4) 1055-1059
    CrossrefPubMedGoogle Scholar
  • 37 Davidson BR, Gibson M, Dick R, Burroughs A, Rolles K. Incidence, risk factors, management, and outcome of portal vein abnormalities at orthotopic liver transplantation. Transplantation 1994; 57 (8) 1174-1177
    CrossrefPubMedGoogle Scholar
  • 38 Ciccarelli O, Goffette P, Laterre PF, Danse E, Wittebolle X, Lerut J. Transjugular intrahepatic portosystemic shunt approach and local thrombolysis for treatment of early posttransplant portal vein thrombosis. Transplantation 2001; 72 (1) 159-161
    CrossrefPubMedGoogle Scholar
  • 39 Haskal ZJ, Naji A. Treatment of portal vein thrombosis after liver transplantation with percutaneous thrombolysis and stent placement. J Vasc Interv Radiol 1993; 4 (6) 789-792
    CrossrefPubMedGoogle Scholar
  • 40 Saad WEA, Darwish WM, Davies MG, Butani D, Waldman DL. Transjugular intrahepatic portosystemic shunts in liver transplant recipients for management of refractory ascites: clinical outcome. J Vasc Interv Radiol 2010; 218-223
    PubMedGoogle Scholar
  • 41 Saad WEA, Darwish WM, Davies MG , et al. Transjugular intrahepatic portosystemic shunts (TIPS) in liver transplant recipients: technical analysis and clinical outcomes. AJR Am J Roentgenol ; In press
    PubMedGoogle Scholar
  • 42 Lerut JP, Goffette P, Molle G , et al. Transjugular intrahepatic portosystemic shunt after adult liver transplantation: experience in eight patients. Transplantation 1999; 68 (3) 379-384
    CrossrefPubMedGoogle Scholar
  • 43 Saad WEA, Davies MG, Lee DE , et al. Transjugular intra-hepatic porto-systemic shunt in a living donor left lateral segment liver transplant recipient: technical considerations. J Vasc Interv Radiol 2005; 16: 873-877
    CrossrefPubMedGoogle Scholar
  • 44 King A, Masterton G, Gunson B , et al. A case-controlled study of the safety and efficacy of transjugular intrahepatic portosystemic shunts after liver transplantation. Liver Transpl 2011; 17 (7) 771-778
    CrossrefPubMedGoogle Scholar
  • 45 Saad WEA, Sabri SS. Balloon-occluded transvenous obliteration (BRTO): technical results and outcomes. Semin Interv Radiol 2011; 28: 333-338
    Article in Thieme ConnectPubMedGoogle Scholar