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Long-term outcomes after stent insertion in patients with early and late hepatic vein outflow obstruction after living donor liver transplantation

Annals of Surgical Treatment and Research 2018년 95권 6호 p.333 ~ 339
 ( Kim Kyeong-Sik ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery

 ( Lee Ji-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Choi Gyu-Sung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Kwon Choon-Hyuck David ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Cho Jae-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Lee Suk-Koo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Park Kwang-Bo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiology
 ( Cho Sung-Ki ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiology
 ( Shin Sung-Wook ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiology
 ( Kim Jong-Man ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery

Abstract

Purpose: The purpose of this study was to describe the long-term effects of stenting in patients with hepatic venous outflow obstruction (HVOO), who underwent living donor liver transplantation (LDLT).

Methods: Between January 2000 and December 2009, 622 adult patients underwent LDLT at our hospital, and of these patients, 21 (3.3%) were diagnosed with HVOO; among these patients, 17 underwent stenting. The patients were divided into early or late groups according to the time of their HVOO diagnoses (cutoff: 60 days after liver transplantation).

Results: The median follow-up period was 54.2 months (range, 0.5?192.4 months). Stent insertion was successful in 8 of 10 patients in the early group and 6 of 7 in the late group. The 5-year primary patency rates were 46% and 20%, respectively. In both groups, patients with recurrent HVOO at the beginning showed kinking confirmed by venography. Patients who carried their stents for more than 3 years maintained long-term patency. There was no significant difference in spleen size between groups; however, when the groups were compared according to whether they maintained patency, spleens tended to be smaller in the patency-maintained group.

Conclusion: Unlike stenosis, if kinking is confirmed on venography, stenting is not feasible in the long term for patients with LDLT.

키워드

Liver transplantation; Hepatic veins; Complications; Stents
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