Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2017; 23(46): 8227-8234
Published online Dec 14, 2017. doi: 10.3748/wjg.v23.i46.8227
Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation
Zhi-Yuan Zhang, Long Jin, Guang Chen, Tian-Hao Su, Zhi-Jun Zhu, Li-Ying Sun, Zhen-Chang Wang, Guo-Wen Xiao
Zhi-Yuan Zhang, Long Jin, Guang Chen, Tian-Hao Su, Guo-Wen Xiao, Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Zhi-Jun Zhu, Li-Ying Sun, Department of Transplantation Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Zhen-Chang Wang, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Zhang ZY and Jin L contributed equally to this work; Zhang ZY, Jin L and Wang ZC designed the research; Zhang ZY, Jin L, Chen G, Su TH, Zhu ZJ, Sun LY and Xiao GW performed the research; Zhang ZY and Jin L analyzed the data; Zhang ZY and Jin L wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Clinical Research Ethics Committee of the Affiliated Beijing Friendship Hospital of Capital Medical University.
Informed consent statement: Informed consent was not required for the study as the analysis used anonymous clinical data. Individuals cannot be identified based on the data presented.
Conflict-of-interest statement: The authors declare no conflicts of interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Long Jin, MD, PhD, Chief Doctor, Professor, Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing 100050, China. zhangzy@mail.ccmu.edu.cn.
Telephone: +86-10-63138454 Fax: +86-10-63138454
Received: October 20, 2017
Peer-review started: October 23, 2017
First decision: October 31, 2017
Revised: November 10, 2017
Accepted: November 22, 2017
Article in press: November 22, 2017
Published online: December 14, 2017
Processing time: 53 Days and 0.8 Hours
ARTICLE HIGHLIGHTS
Research background

Liver transplantation is the most effective treatment for end-stage liver disease. Hepatic venous outflow obstruction (HVOO) is a severe complication of pediatric liver transplantation, which has a high incidence of 4%-9% owing to the smaller anastomosis diameter and size mismatch of the hepatic vessels between the donor and recipient. Endovascular angioplasty is a less-invasive therapeutic option that has become the first-line treatment option in pediatric transplant recipients. However, it remains controversial whether stent placement or balloon angioplasty is required for patients with HVOO. Rare cases of HVOO have been reported in pediatric patients following liver transplantation. This study reported our experiences with using balloon dilatation as part of the treatment for HVOO in five children subjected to pediatric liver transplantation, providing valuable data for the successful treatment of such patients.

Research motivation

HVOO is a rare and severe complication following pediatric liver transplantation that leads to graft loss in the majority of patients. However, it remains controversial whether stent placement or balloon angioplasty is required for patients with HVOO. This study reported our experiences with using balloon dilatation as part of the treatment for HVOO in five children subjected to pediatric liver transplantation, providing valuable information for the successful treatment of such patients. Balloon dilatation is an effective and safe treatment for HVOO in pediatric patients following liver transplantation, and re-venoplasty is recommended even for patients with recurrent HVOO.

Research objectives

Balloon dilatation is an effective and safe treatment for HVOO in pediatric patients following liver transplantation, and re-venoplasty is recommended even for patients with recurrent HVOO.

Research methods

The authors enrolled a total of 246 pediatric patients who underwent liver transplantation between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Percutaneous interventions were performed under general anesthesia in all patients (n = 5). The demographic data, types of donor and liver transplant, interventional examination and therapeutic outcomes of these five children were collected and analyzed with SPSS version 21.0 software. Changes between pre- and post-procedural pressure gradients across the hepatic vein stenosis were analyzed by paired Student’s t-test.

Research results

The authors found that balloon dilatation is an effective and safe treatment for HVOO in pediatric patients following liver transplantation. The hepatic vein stenosis rate was 1.62%. The time to onset of hepatic vein stenosis ranged from 1-32 mo (mean: 9.80 mo) after liver transplantation. The pressure gradient across the stenotic lesions at the anastomoses before balloon dilatation decreased significantly after the procedure (P < 0.05). Sustained follow-up did not reveal significant procedural complications or procedure-related deaths. Further studies with a larger sample size that could identify relevant risk factors for HVOO development following transplantation and HVOO recurrence after balloon angioplasty are needed.

Research conclusions

This study investigated the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction following pediatric liver transplantation. HVOO is a rare and severe complication following pediatric liver transplantation that leads to graft loss in the majority of patients. However, it remains unclear whether stent placement or balloon angioplasty is required for patients with HVOO. This study reported our experiences with using balloon dilatation as part of the treatment for HVOO in five children subjected to pediatric liver transplantation, providing valuable information regarding the successful treatment of such patients. Balloon dilatation is an effective and safe treatment for HVOO in pediatric patients following liver transplantation, and re-venoplasty is recommended even for patients with recurrent HVOO. In spite of the technical success and satisfactory clinical outcomes in these five children, the present study had certain limitations, including the retrospective nature of the study, a relatively small sample size, and a short follow-up period. Further studies with a large sample size that could identify risk factors for HVOO development following transplantation and HVOO recurrence after balloon angioplasty are needed.

Research perspectives

This study reported our experiences with using balloon dilatation as part of the treatment for HVOO in five children subjected to pediatric liver transplantation, providing valuable information for the successful treatment of such patients. Balloon dilatation is an effective and safe treatment for HVOO in pediatric patients following liver transplantation, and re-venoplasty is recommended even for patients with recurrent HVOO. In spite of the technical success and satisfactory clinical outcomes in these five children, the present study had certain limitations, including the retrospective nature of the study, a relatively small sample size, and a short follow-up period. Further studies with a large sample size that could identify risk factors for HVOO development following transplantation and HVOO recurrence after balloon angioplasty are needed.