REGULAR CONTENT
Final ID
550
Type
Original Scientific Research-Oral or Pos
Authors
C Stoneburner1, D Sella2, A Devine3, G Frey3, J McKinney3, R Paz-Fumagalli4
Institutions
1Mayo Clinic Jacksonville, Jacksonville, FL, 2Mayo Clinic Florida, Jacksonville, FL, 3Mayo Clinic, Jacksonville, FL, 4N/A, Ponte Vedra Beach, FL
Purpose
Donation after cardiac death (DCD) can help alleviate the scarcity of solid organs for transplantation; however, DCD liver transplants have worse outcomes compared to donation after brain death (DBD), mainly from biliary complications. This study aimed to determine if the type of donation can impact the rate of intervention for hepatic vein anastomotic stenosis and outcomes of balloon dilatation and/or stent placement.
Materials & Methods
IRB approval was obtained for this retrospective review of all DBD and DCD liver transplants complicated by hepatic vein stenosis treated with balloon dilatation and/or stenting from January 1998 to December 2015. Data collected included demographics, indications for balloon dilatation/stent, venous anastomosis pressure gradient measurements, balloon dilatation alone or balloon dilatation with stenting, and technical and clinical success (improvement or resolution of clinical indication) of the intervention.
Results
Intervention for hepatic vein anastomosis stenosis was done in 45/2353 (1.9%) DBD and 8/301 (2.7%) DCD (p=0.38). Balloon dilatation alone was done in 38/53 and angioplasty/stent in 15/53. Persistent ascites was the indication in 37/45 (82%) DBD and 8/8 (100%) DCD (p=0.3). Stents had superior technical results compared to balloon dilatation, with mean post-procedure residual pressure gradient of 0 mmHg (range: 0-2 mmHg) and 7 mmHg (range: 0-22 mmHg), respectively (p <0.001). Use of stents did not differ significantly in DBD v. DCD. Clinical success was 73% for stents and 34% for balloon dilatation (p=0.01).
Conclusions
The type of organ donation (brain or cardiac death) does not impact the rate of post-transplant hepatic vein stenosis or outcomes when treated with balloon dilatation or stent. The technical and clinical success of stenting are significantly superior to balloon dilatation regardless of donation type.
Final ID
550
Type
Original Scientific Research-Oral or Pos
Authors
C Stoneburner1, D Sella2, A Devine3, G Frey3, J McKinney3, R Paz-Fumagalli4
Institutions
1Mayo Clinic Jacksonville, Jacksonville, FL, 2Mayo Clinic Florida, Jacksonville, FL, 3Mayo Clinic, Jacksonville, FL, 4N/A, Ponte Vedra Beach, FL
Purpose
Donation after cardiac death (DCD) can help alleviate the scarcity of solid organs for transplantation; however, DCD liver transplants have worse outcomes compared to donation after brain death (DBD), mainly from biliary complications. This study aimed to determine if the type of donation can impact the rate of intervention for hepatic vein anastomotic stenosis and outcomes of balloon dilatation and/or stent placement.
Materials & Methods
IRB approval was obtained for this retrospective review of all DBD and DCD liver transplants complicated by hepatic vein stenosis treated with balloon dilatation and/or stenting from January 1998 to December 2015. Data collected included demographics, indications for balloon dilatation/stent, venous anastomosis pressure gradient measurements, balloon dilatation alone or balloon dilatation with stenting, and technical and clinical success (improvement or resolution of clinical indication) of the intervention.
Results
Intervention for hepatic vein anastomosis stenosis was done in 45/2353 (1.9%) DBD and 8/301 (2.7%) DCD (p=0.38). Balloon dilatation alone was done in 38/53 and angioplasty/stent in 15/53. Persistent ascites was the indication in 37/45 (82%) DBD and 8/8 (100%) DCD (p=0.3). Stents had superior technical results compared to balloon dilatation, with mean post-procedure residual pressure gradient of 0 mmHg (range: 0-2 mmHg) and 7 mmHg (range: 0-22 mmHg), respectively (p <0.001). Use of stents did not differ significantly in DBD v. DCD. Clinical success was 73% for stents and 34% for balloon dilatation (p=0.01).
Conclusions
The type of organ donation (brain or cardiac death) does not impact the rate of post-transplant hepatic vein stenosis or outcomes when treated with balloon dilatation or stent. The technical and clinical success of stenting are significantly superior to balloon dilatation regardless of donation type.