Utility of liver biopsy in predicting clinical outcomes after percutaneous angioplasty for hepatic venous obstruction in liver transplant patients

Table 1 Pre- and post-procedure gradients, biopsy findings and clinical outcomes

Patient No.	Procedure No.	Gradient (mmHg)		Biopsy findings indicating HVOO			Clinical outcome
		Pre	Post	Pre-	< 60 d	> 60 d
1	1	8	NA	+	+	-	Good
2	1	7	NA	-	-	-	Good
3	1	8	4	+	+	-	Good
4	1	5	8	-	+	-	Good
5	1	9	9	NA	NA	-	Good
6	1	2	1	NA	NA	NA	Good
	2	5	4	-	NA	NA	Poor
7	1	15	17	+	+	NA	Poor
	2	17	12	+	NA	NA	Poor
8	1	7	2	+	NA	NA	Poor
9	1	NA	NA	+	NA	+	Poor
	2	6	1	+	NA	NA	Good
10	1	5	NA	-	NA	NA	Good
11	1	9	2	+	-	+	Poor
	2	8	1	-	NA	-	Good
12	1	2	2	+	NA	NA	Good
13	1	4	NA	+	-	-	Good
14	1	8	6	+	+	NA	Poor
	2	5	4	+	+	NA	Poor
	3	11	5	+	NA	NA	Poor
15	1	11	8	-	+	NA	Poor

HVOO: Hepatic venous obstruction; NA: Not available.

Table 2 Clinical outcomes in patients with both early (< 60 d) and late (> 60 d) biopsy after percutaneous transluminal angioplasty for hepatic venous obstruction

Early biopsy findings	Late biopsy findings	Clinical outcome (days post-PTA)
HVOO (3 patients )	No HVOO (3/3)	Non-HVOO related death (205 d)
		Non-HVOO related death (242 d)
		Doing well (3096 d)
No HVOO (3 patients )	No HVOO (2/3)	Doing well (62, 964 d)
	HVOO (1/3)	Needed repeat PTA (66 d)

PTA: Percutaneous transluminal angioplasty; HVOO: Hepatic venous obstruction.

Table 3 Published studies of efficacy of percutaneous treatment of hepatic venous obstruction using the Kaplan-Meier method

Ref.	Transplant	Procedure	n	Follow-up	Primary patency rates									Primary assisted patency rates									Outcomes	Complications
	type			(converted to weeks)	1 mo	3 mo	6 mo	12 mo	18 mo	36 mo	60 mo	84 mo	120 mo	1 mo	3 mo	6 mo	12 mo	18 mo	36 mo	60 mo	84 mo	120 mo
Kubo et al[4]	LDLT	19 PTA, 1 PTA + stent	20	20-334 wk (med: 129 wk)			80	65	60		60	60	NA			100	100	100		100	NA	NA	9/20 recurrence, 0% retransplanted, 0% HVOO death	n = 1, transient hypotension
Lorenz et al[7]	OLT 15 LDLT 1	12 PTA, 2 PTA + stent, 3 only stent	16	45-244 wk (mean: 161 wk)	100	75		67	67	60	NA	NA	NA	93	91	90	89	88	83	NA	NA	NA	3/12 recurrence, 3/12 retransplanted, 3/12 non-HVOO deaths, 1/12 HVOO death	n = 1, transient hypoxia
Ko et al[3]	LDLT	108 only stent	108	52-360 wk (mean: 39 mo)					82		75	72	NA	NR	NR	NR	NR	NR	NR	NR	NR	NR	22/108 recurrence, 2/108 retransplanted, 3 HVOO deaths	4.60%, stent migration, stent malposition
Ikeda et al[6]	LDLT	9 PTA, 2 PTA + stent	11	20-292 wk (med: 60 wk)	78	78	67	67	56			56	NA	100	100	100	100			100	NA	NA	6/10 recurrence, 1/10 retransplanted, 2/10 death, 2/2 hepatic	n = 1, abdominal pain
Yabuta et al[8]	LDLT	41 PTA, 7 PTA + stent	48	4-728 wk (med: 206 wk)				64		57	57		52				98		95	95		95	20/48 recurrence, 2/48 retransplanted, 0/48 HVOO-related deaths	n = 1, stent migration
Lorenz et al[9]	OLT 23 LDLT 2	14 PTA, 4 PTA + stent, 10 only stent	25	1-603 wk (mean: 192 wk)			57	51		51	51	51	NA			57	51		51	51	51	NA	6/14 recurrence, 1/14 retransplanted, 3/14 died of primary graft failure	n = 1, fractured stent

LDLT: Living donor liver transplant; OLT: Orthotropic liver transplant; PTA: Percutaneous transluminal angioplasty; NA: Not available; NR: Not reported.