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Published on: June 27, 2025
Percutaneous treatment of venous outflow obstruction in pediatric liver transplants
Jonathan M Lorenz1, Thuong Van Ha, Brian Funaki
1Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, Illinois 60637, USA. jlorenz@radiology.bsd.uchicago.edu
Insights
Percutaneous dilation effectively treats impaired venous outflow in pediatric liver transplant recipients. While initial success is high, repeated interventions may be needed for long-term patency.
Area of Science:
- Interventional Radiology
- Pediatric Hepatology
- Transplant Surgery
Background:
- Impaired venous outflow is a potential complication following pediatric liver transplantation.
- Hepatic venous or inferior vena cava anastomosis obstruction can lead to significant morbidity.
Purpose of the Study:
- To assess the efficacy and safety of percutaneous dilation for treating impaired venous outflow in pediatric liver transplant patients.
- To determine technical and clinical success rates, as well as patency rates, following the intervention.
Main Methods:
- A review of 35 percutaneous dilation procedures in 16 pediatric liver transplant recipients over 8 years.
- Patients with clinical signs or abnormal imaging of venous outflow obstruction were treated with venoplasty, with stenting for incomplete resolution or significant pressure gradients.
Main Results:
- A combined technical success rate of 94% (15/16) and clinical success rate of 81% (13/16) were achieved.
- Primary patency rates ranged from 72.7% at 3 months to 50% at 36 months, with assisted and secondary patency rates significantly higher.
Conclusions:
- Percutaneous dilation offers excellent technical and clinical success for managing impaired venous outflow post-pediatric liver transplant.
- Long-term management may necessitate repeat interventions to maintain vessel patency.
Purpose:
To evaluate the efficacy and safety of percutaneous dilation in the treatment of impaired venous outflow in pediatric patients with liver transplants.
Materials And Methods:
Review was undertaken of the records of 35 procedures to dilate impaired venous outflow in 16 consecutive children (aged 11 days to 17.8 years; mean, 7.2 +/- 5.8 y) after liver transplantation over a period of 8 years. Patients presented clinically with signs or symptoms of obstruction of the hepatic venous or inferior vena cava anastomosis and/or abnormal noninvasive imaging findings and were referred primarily to the interventional radiology department for treatment. None were excluded. Technical and clinical success rates were calculated. After venoplasty, patients with incomplete venographic resolution or pressure gradients exceeding 5 mm Hg were treated with stents. Seven died or required repeat transplantation during the study period for reasons unrelated to venous outflow obstruction. Patency rates were calculated for all other patients with sufficient follow-up in the pediatric hepatology clinic.
Results:
The combined technical success rate for venoplasty (12 of 16) and stent placement (three of 16) was 94% (15 of 16), and the clinical success rate was 81% (13 of 16). One minor complication occurred: a transient hypoxic episode. Primary patency rates were 72.7% (eight of 11) at 3 months, 60% (six of 10) at 6 months, 55.6% (five of nine) at 12 months, 50% (four of eight) at 18 months, and 50% (three of six) at 36 months. Primary assisted and secondary patency rates were 90.9% (10 of 11) at 3 months, 90% (nine of 10) at 6 months, 88.9% (eight of nine) at 12 months, 87.5% (seven of eight) at 18 months, and 83.3% (five of six) at 36 months.
Conclusions:
Excellent technical and clinical success rates can be achieved with percutaneous dilation of impaired venous outflow after pediatric liver transplantation. Long-term patency may require repeated interventions.
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