Angioplasty treatment of hepatic vein stenosis in pediatric liver transplants: long-term results

We reviewed long-term results of percutaneous venoplasty in children with hepatic vein stenosis after partial liver transplants, of which excellent early results were shown. Percutaneous transjugular hepatic venoplasty using balloon dilatation or stent implantation was performed in six cases with hepatic vein stenosis identified on routine post-transplant Doppler sonography and confirmed by transjugular hepatic venography from 1994 to 2003. Repeated procedure was carried out if necessary. Six of 105 patients with partial liver graft developed hepatic stenosis characterized by low hepatic venous velocity with monophasic waveform with significant pressure gradient (> 5 mmHg). The incidence was 4.46% for all 112 pediatric liver transplants. Successful balloon venoplasty was achieved in four cases. Self-expanding stent was used in two cases with absent waisting or angulated balloon catheter during dilatation and persisted pressure gradient (> 5 mmHg). Repeated procedure was required in two initially successful cases with additional stent used in one case. Three cases had transient hyperdynamic hepatic venous flow with markedly increased central venous pressure after stent implantation. Nonprocedural-related mortality rate was 16.7%. Patent hepatic vein was maintained in five patients after a mean follow-up of 3.67 years (0.75-9.5). Higher incidence of hepatic vein stenosis was noted in pediatric partial liver transplant. However, encouraging long-term results showed that hepatic venoplasty or stent implantation could be a preferable alterative to surgical revision or retransplantation, which has been the procedure of choice in our hospital.