ORTHOTOPIC LIVER TRANSPLANTATION: ROLE OF INTERVENTIONAL RADIOLOGY
https://doi.org/10.15825/1995-1191-2009-3-42-50
Abstract
To study therapeutic modalities of interventional radiology in patients (pts) before and after orthotopic liver trans- plantation (OLT). OLT was performed in 53 pts between 1998 and 2008. Endovascular treatments were performed in 20 pts. Pre-OLT interventional procedures included transcatheter arterial chemoembolization (5 patients) and TIPS (8 patients). Post-OLT procedures were: dilatation or/and stenting of biliary strictures (4), stenting of IVC (2), balloon dilatation of cava-caval anastomosis (1), partial splenic embolization (PSE) in steel syndrome (1). All IR procedures were technically successful. There was no mortality or serious complication. After chemoemboliza- tion, there was partial tumor response in all 5 patients with HCC; two successfully transplanted are alive without recurrence in 11 and 15 months. After TIPS, 3 pts underwent OLT. Satisfactory biliary passage was achieved in all pts with strictures. Clinical symptoms and liver function improved in three pts with venous strictures. After PSE, steal syndrome regressed rapidly. All pts are asymptomatic and well in 5–24 mo after IR treatment. IR procedures prolong long-term patient survival before OLT and may improve outcomes in pts after OLT.
About the Authors
P. G. Tarazov
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
D. A. Granov
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
A. A. Polikarpov
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
M. I. Generalov
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
F. K. Zherebtsov
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
O. A. Krotova
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
O. A. Gerasimova
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
D. N. Maystrenko
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
A. V. Kozlov
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
I. O. Rutkin
Federal State Institution «Russian Research Centre of Radiology and Surgical Tehnologies» of the Federal Agency on High Technique Medical Care, Saint-Petersburg
Russian Federation
Russian Federation
References
1. Готье С.В. Трансплантация печени: современное состояние проблемы // Альманах ин-та хирургии им. А.В. Вишневского. 2008. Т. 3. No 3. С. 9–17.
2. Гранов Д.А. Трансплантация печени при гепатоцел- люлярном раке // Практическая онкология. 2008. Т. 9. No 5. С. 237–240.
3. Затевахин И.И., Шиповский В.Н., Монахов Д.В., Ша- гинян А.К. TIPS – новый метод лечения осложнений портальной гипертензии // Анналы хирургии. 2008. No 2. С. 43–46.
4. Карев А.В., Рыжков В.К., Петрова С.Н., Борисов А.Е. Новый стент из мононити нитинола в создании чрес- кожного чреспеченочного портосистемного соус- тья // Вестник рентгенологии. 2003. No 5. С. 40–42.
5. Рыжков В.К., Карев А.В., Борисов А.Е., Петрова С.Н. Внутрипеченочный портокавальный шунт в лечении портальной гипертензии при циррозе печени // Вест- ник хирургии. 2007. Т. 166. No 4. С. 11–15.
6. Таразов П.Г. Чрезъяремный внутрипеченочный пор- токавальный анастомоз при лечении портальной гипертензии (обзор литературы) // Хирургия. 1999. No 7. С. 64–69.
7. Таразов П.Г. Рентгеноэндоваскулярные вмешательс- тва в лечении первичного рака печени // Практичес- кая онкология. 2008. Т. 9. No 4. С. 209–215.
8. Alba E., Valls C., Dominguez J. et al. Transcatheter arterial chemoembolization in patients with hepatocellular carcinoma on the waiting list for orthotopic liver transplantation // Am. J. Roentgenol. 2008. Vol. 190. No 5. P. 1341–1348.
9. Bárcena R., Moreno A., Foriny J.R. et al. Improved graft function in liver-transplanted patients after partial splenic embolization: Reversal of splenic artery steal syndrome? // Clin. Transplant. 2006. Vol. 20. P. 517– 523.
10. Bharat A., Brown D.B., Crippin J.S. et al. Pre-liver transplantation locoregional adjuvant therapy for hepatocellular carcinoma as a strategy to improve longterm survival // J. Am. Coll. Surg. 2006. Vol. 203. No 4. P. 411–420.
11. Carnevale F.C., Machado A.T., Moreira A.M. et al. Midterm and long-term results of percutaneous endovascular treatment of venous outflow obstruction after pediatric liver transplantation // J. Vasc. Intervent. Radiol. 2008. Vol. 19. No 10. P. 1439–1448.
12. Cavallari A., Vivarelli M., Bellusci R. et al. Treatment of vascular complications following liver transplantation: Multidisciplinary approach // Hepatogastroenterology. 2001. Vol. 48. No 37. P. 179–183.
13. Chao C.P., Nguyen J.H., Paz-Fumagalli R. et al. Splenic embolization in liver transplant recipients: Early outcomes // Transplant. Proc. 2007. Vol. 39. No 10. P. 3194–3198.
14. Chapman W.C., Majella Doyle M.B., Stuart J.E. et al. Outcomes of neoadjuvant transarterial chemoemboli- zation to doqnstage hepatocellular carcinoma before liver transplantation // Ann. Surg. 2008. Vol. 248. No 4. P. 617–624.
15. Cheng Y.F., Chen Y.S., Huang T.L. et al. Interventional radiologic procedures in liver transplantation // Transpl. Int. 2001. Vol. 14. No 4. P. 223–229.
16. Chui A.K.K., Rao A.R.N., Waugh R.C. et al. Liver transplantation in patients with transjugalar intrahepatic portosystemic shunts // Aust. N.Z. J. Surg. 2000. Vol. 70. P. 493–495.
17. Cosenza C.A., Hoffman A.L., Friedman M.L. et al. Transjugular intrahepatic portosystemic shunt: Efficacy for the treatment of portal hypertension and impact on liver transplantation // Am. Surgeon. 1996. Vol. 62. No 10. P. 835–839.
18. Da Silva R.F., Raphe R., Felício H.C. et al. Prevalence, treatment, and outcomes of the hepatic artery stenosis after liver transplantation // Transplant. Proc. 2008. Vol. 40. No 3. P. 805–807.
19. Egawa H., Tanaka K., Uemoto S. et al. Relief of hepatic vein stenosis by balloon angioplasty after living-related donor liver transplantation // Clin. Transplant. 1993. Vol. 7. No 4. P. 306–311.
20. Ferguson J.W., Hayes P.C. Transjugular intrahepatic por- tosystemic shunt in the prevention of rebleeding in oe- sophageal varices // Eur. J. Gastroenterol. Hepatol. 2006. Vol. 18. No 11. P. 1167–1171.
21. Glockner J.F., Forauer A.R. Vascular or ischemic complications after liver transplantation: Pictorial assay // Am. J. Roentgenol. 1999. Vol. 173. No 4. P. 1055– 1059.
22. Graziadei I.W., Sandmueller H., Waldenberger P. et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impeded tumor progression while on the waiting list and leads to excellent outcome // Liver Transpl. 2003. Vol. 9. No 6. P. 557–563.
23. Hampe T., Dogan A., Encke J. et al. Biliary complications after liver transplantation // Clin. Transplant. 2006. Vol. 20. Suppl. 17. P. 93–96.
24. Harnois D.M., Steers J., Andrews J.C. et al. Preoperative hepatic artery chemoembolization followed by orthotopic liver transplantation for hepatocellular carcinoma // Liver Transplant. Surg. 1999. Vol. 5. No 3. P. 192–199.
25. Hayashi P.H., Ludkowski M., Forman L.M. Hepatic artery chemoembolization for hepatocellular carcinoma in patients listed for liver transplantation // Am. J. Transplant. 2004. Vol. 4. No 5. P. 782–787.
26. Hidajat N., Vogl T., Stobbe H. et al. Transjugular in- trahepatic portosystemic shunt: Experiences at a liver transplantation center // Acta Radiologica. 2000. Vol. 41. No 5. P. 474–478.
27. Huang Q., Zhai R.Y., Dai D.K. Interventional treatment of hepatic artery stenosis after orthotopic liver transplantation with balloon-expandable coronary stent // Transplant. Proc. 2007. Vol. 39. No 10. P. 3245–3250.
28. Kim D.Y., Choi M.S., Lee J.H. et al. Milan criteria are useful predictors for favorable outcomes in hepatocel- lular carcinoma patients undergoing liver transplantation after transarterial embolization // World J. Gastroenterol. 2006. Vol. 12. No 43. P. 6992–6997.
29. Kyoden Y., Tamura S., Sugawara Y. et al. Portal vein complications after adult-to-adult living donor liver transplantation // Transplant. Int. 2008. Vol. 21. No 12. P. 1136–1144.
30. Maluf D.G., Stravitz R.T., Williams B. et al. Multimo- dality therapy and liver transplantation in patients with cirrhosis and hepatocellular carcinoma: 6 years, single- center experience // Transplant Proc. 2007. Vol. 39. No 1. P. 153–159.
31. McAvoy N.C., Hayes P.C. The use of transjugular intrahepatic portosystemic stent shunt in the management of acute oesophageal variceal haemorrhage // Eur. J. Gastroenterol. Hepatol. 2006. Vol. 18. No 11. P. 1135– 1141.
32. Millonig G., Graziadei I.W., Freund M.C. et al. Response to preoperative chemoembolization correlates with outcome after liver transplantation in patients with hepatocellular carcinoma // Liver Transpl. 2007. Vol. 13. No 2. P. 272–279.
33. Mizuno S., Sanda R., Hori T. et al. Maximizing venous outflow after right hepatic living donor liver transplanta- tion with a venous graft patch // Dig. Surg. 2008. Vol. 25. No 1. P. 67–73.
34. Obed A., Beham A., Püllman K. et al. Patients without hepatocellular carcinoma progression after transarterial chemoembolization benefit from liver transplantation // World J. Gastroenterol. 2007. Vol. 13. No 5. P. 761–767.
35. Ong J.P., Sands M., Younossi Z.M. Transjugular intra- hepatic portosystemic shunts (TIPS): A decade later // J. Clin. Gastroenterol. 2000. Vol. 30. P. 14–28.
36. Otto G., Herber S., Heise M. et al. Response to transarte- rial chemoembolization as a biological selection criteri- on for liver transplantation in hepatocellular carcinoma // Liver Transpl. 2006. Vol. 12. No 8. P. 1260–1267.
37. Quintini C., Hirose K., Hashimoto K. et al. «Splenic ar- tery steal syndrome» is a misnomer: The cause is portal hypertension, not arterial siphon // Liver Transpl. 2008. Vol. 14. P. 374–379.
38. Rösch J., Keller F.S. Transjugular intrahepatic porto- systemic shunt: Present status, comparison with endo- scopic therapy and shunt surgery, and future perspec- tives // World J. Surg. 2001. Vol. 25. P. 337–345.
39. Ter Borg P.C., Hollemans M., Van Buuren H.R. et al. Transjugular intrahepatic portosystemic shunts: Long- term patency and clinical results in a patient cohort ob- served for 3–9 years // Radiology. 2004. Vol. 231. No 2. P. 537–545.
40. Uflacker R., Selby J.B., Chavin K. et al. Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation // Cardiovasc. Intervent. Radiol. 2002. Vol. 25. P. 300– 306.
41. Zheng M., Chen Y., Bai J. et al. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients: Meta-analysis update // J. Clin. Gastroenterol. 2008. Vol. 42. P. 507–516.
Review
For citations:
Tarazov P.G., Granov D.A., Polikarpov A.A., Generalov M.I., Zherebtsov F.K., Krotova O.A., Gerasimova O.A., Maystrenko D.N., Kozlov A.V., Rutkin I.O. ORTHOTOPIC LIVER TRANSPLANTATION: ROLE OF INTERVENTIONAL RADIOLOGY. Russian Journal of Transplantology and Artificial Organs. 2009;11(3):42-50. (In Russ.) https://doi.org/10.15825/1995-1191-2009-3-42-50
Views:
734
Email this article 