Long-term outcome of percutaneous transhepatic balloon angioplasty for portal vein stenosis after pediatric living donor liver transplantation: a single institute's experience.

PURPOSE: To evaluate retrospectively the long-term outcomes of percutaneous transhepatic balloon angioplasty performed for portal vein stenosis (PVS) after pediatric living donor liver transplantation (LDLT). MATERIALS AND METHODS: Between October 1997 and December 2013, of 527 pediatric patients (age < 18 y) who underwent LDLT in a single institution, 43 patients (19 boys, 24 girls; mean age, 4.1 y ± 4.1) were confirmed to have PVS at direct portography with or without manometry and underwent percutaneous interventions, including balloon angioplasty with or without stent placement. Technical success, clinical success, laboratory findings, manometry findings, patency rates, and major complications were evaluated. Follow-up periods after initial balloon angioplasty ranged from 5-169 months (mean, 119 mo). RESULTS: Technical success was achieved in 65 of 66 sessions (98.5%) and in 42 of 43 patients (97.7%), and clinical success was achieved in 37 of 43 patients (86.0%). Platelet counts improved significantly. Of 32 patients undergoing manometry, 19 showed significant improvement of pressure gradient across the stenosis after percutaneous transhepatic balloon angioplasty. At 1, 3, 5, and 10 years after balloon angioplasty, the rates of primary patency were 83%, 78%, 76%, and 70%, and the rates of primary-assisted patency were 100%, 100%, 100%, and 96%. Two major complications subsequent to balloon angioplasty were noted: severe asthma attack and portal vein thrombosis. CONCLUSIONS: Percutaneous transhepatic balloon angioplasty is a safe and effective treatment with long-term patency for PVS after pediatric LDLT.

Long-term outcome of percutaneous interventions for hepatic venous outflow obstruction after pediatric living donor liver transplantation: experience from a single institute.

PURPOSE: To evaluate retrospectively the long-term outcome of percutaneous interventions for hepatic venous outflow obstruction (HVOO) occurring after pediatric living donor liver transplantation (LDLT). MATERIALS AND METHODS: Between October 1997 and December 2012, 48 patients (24 boys, 24 girls; median age, 6 y) who had undergone LDLT were confirmed to have HVOO using percutaneous hepatic venography and manometry. All patients underwent percutaneous interventions, including balloon angioplasty with or without stent placement. Technical success, clinical success, patency rates, stent placement, and major complications were evaluated. RESULTS: Technical success was achieved in 92 of 93 sessions (99.0%) and in 47 of 48 patients (97.9%), and clinical success was achieved in 41 of 48 patients (85.4%). During the follow-up period (range, 1-182 mo; median, 51.5 mo), 28 patients were treated with a single session of balloon angioplasty, and 20 patients who developed recurrent stenosis were treated with repeated percutaneous interventions. The rates of primary and primary-assisted patency at 1, 3, 5, and 10 years after balloon angioplasty were 64%, 57%, 57%, and 52% (primary patency) and 98%, 95%, 95%, and 95% (primary-assisted patency). Of six patients with stent placement, four had no recurrent HVOO after the stent placement, but two developed recurrent stenosis. The stent migrated to the right atrium in one patient. CONCLUSIONS: Percutaneous interventions were effective treatments for HVOO after LDLT.

Evaluation of biliary abnormalities with 64-channel multidetector CT.

Precise preoperative assessment of the vascular and biliary anatomy is important in ensuring the safety of hepatobiliary surgical procedures, including laparoscopic cholecystectomy, living donor liver transplantation, and tumor resection of the liver. Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography clearly depict the biliary anatomy but are considered invasive procedures. Magnetic resonance cholangiopancreatography is noninvasive but sometimes fails to depict the normal intrahepatic bile ducts. Multidetector computed tomography (CT) has contributed greatly to the evaluation of the normal anatomy, anatomic variants, and disease extent in this setting. With 64-channel multidetector CT, high-resolution three-dimensional images can be reconstructed from isotropic data with a 0.625-mm section thickness. Because of its capacity for thin-section scanning and multiplanar reformation, 64-channel multidetector CT cholangiography can clearly demonstrate the biliary anatomy, a variety of anatomic variants, and the extent of disease--information that is indispensable for successful hepatobiliary surgery.

Transcatheter arterial embolization for tumor seeding in the chest wall after radiofrequency ablation for hepatocellular carcinoma.

Tumor seeding in the chest wall was depicted at follow-up CT obtained 9 months after radiofrequency ablation for hepatocellular carcinoma. Transcatheter arterial embolization was successfully performed, injecting emulsion of 10 mg of epirubicin and 1 ml of iodized oil followed by gelatin sponge particles via the microcatheter placed in the right eleventh intercostal artery. The patient died of tumor growth in the liver one year after the embolization, but no progression of the tumor seeding was noted during the follow-up period. We conclude that transcatheter arterial embolization was effective for the control of tumor seeding after radiofrequency ablation for hepatocellular carcinoma.

Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode.

PURPOSE: To prospectively compare the effectiveness of radiofrequency (RF) ablation performed by using an internally cooled electrode and an expandable electrode for the treatment of small (< or = 3.0 cm) hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: The human subjects research review board at the study institution approved the protocol, and each patient provided informed consent. Seventy-four patients (58 men and 16 women; age range, 41-83 years) with 83 HCC nodules 3 cm or smaller were randomly divided into an internally cooled electrode group (38 patients with 41 nodules) and an expandable electrode group (36 patients with 42 nodules). RF ablation was performed by one individual. Primary technique effectiveness and rates of major complications were evaluated between the two groups with the Fisher exact test. Rates of local tumor progression, overall survival, local progression-free survival, and event-free survival were evaluated by using the Kaplan-Meier method. RESULTS: The primary technique effectiveness was 95% in the internally cooled electrode group and 93% in the expandable electrode group (P = .51); rates of major complications were 0% and 2.1% per session (P = .50) and 0% and 2.8% per patient (P = .49), respectively. Rates at 1, 2, and 3 years in the internally cooled electrode group versus the expandable electrode group were as follows: local tumor progression, 12% versus 17%, 20% versus 22%, and 20% versus 22% (P = .72, log-rank test); overall survival, 100% versus 94%, 94% versus 92%, and 94% versus 77% (P = .29, log-rank test); local progression-free survival, 87% versus 78%, 73% versus 66%, and 73% versus 46% (P = .27, log-rank test); and event-free survival, 47% versus 44%, 34% versus 22%, and 34% versus 22% (P = .40, log-rank test). CONCLUSION: On the basis of the study findings, RF ablation with an internally cooled electrode needle and an expandable electrode needle has equivalent effectiveness for the treatment of small HCCs.

Percutaneous transhepatic balloon dilation of portal venous stenosis in patients with living donor liver transplantation.

PURPOSE: To retrospectively evaluate the long-term effectiveness of percutaneous transhepatic balloon dilation of portal venous stenosis in patients who have undergone living donor liver transplantation. MATERIALS AND METHODS: Institutional review board approval and informed consent were not required. From June 1996 to August 2003, obstructed portal venous blood flow was diagnosed in 45 patients (21 male, 24 female) with a history of living donor liver transplantation; patients ranged in age from 9 months to 61 years (mean, 9.2 years). All stenoses occurred in the extrahepatic portal vein near the anastomosis of the portal vein. All dilation procedures were performed with percutaneous transhepatic puncture of the intrahepatic portal vein and subsequent balloon dilation of the stenosis. Patients who experienced recurrent stenosis underwent another balloon dilation session. Intravascular metallic stents were not deployed because of the possible need for repeated transplantation. The authors used paired t tests to compare patients successfully treated with one venoplasty procedure and those requiring repeated venoplasty, with regard to age and stenosis diameter percentages before and after the initial procedure. RESULTS: Percutaneous balloon dilation was technically successful in 35 of 45 patients. In the remaining 10 patients, portal venous thrombotic occlusion precluded access to the mesenteric side of the portal vein. Twenty-five patients were successfully treated with a single session of balloon dilation (group 1). Results at follow-up ultrasonography revealed restenosis in 10 of 35 patients. Recurrent stenosis was resolved by means of repeated balloon dilation in nine patients (group 2). There were no significant differences between groups 1 and 2 in age (P = .87) or in stenosis diameter percentages before (P = .053) or after (P = .95) the initial procedure. CONCLUSION: Percutaneous transhepatic balloon dilation seems to be an effective method for treatment of portal venous stenosis after living donor liver transplantation.

Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome.

Computed tomography (CT)-guided transthoracic radiofrequency ablation was performed for nine liver tumors of eight patients, which were located in the hepatic dome and undetectable by ultrasound (US). A total 11 sessions of ablation were performed. Complications were noted in five sessions (45%) and no complications were noted in six sessions (55%). Pneumothorax was noted in five sessions (45%), including two sessions (18%) with major pneumothorax requiring a chest tube. Major complications were seen in two sessions (18%), major pneumothorax and both major pneumothorax and moderate pleural effusion, respectively. CT-guided transthoracic radiofrequency ablation may be an alternative for treatments of liver tumor in the hepatic dome.

Cholangitis and liver abscess after percutaneous ablation therapy for liver tumors: incidence and risk factors.

PURPOSE: To determine the risk factors of cholangitis and liver abscess occurring after percutaneous ablation therapy for liver tumors. MATERIALS AND METHODS: Between October 1995 and September 2002, 358 patients with 455 liver tumors underwent a total of 683 ablation procedures, such as percutaneous ethanol injection (PEI), percutaneous microwave coagulation (PMC), and radiofrequency (RF) ablation therapy. With a retrospective review of medical records, the rates and outcomes of cholangitis and/or liver abscess occurring after ablation therapy were evaluated. The relationship between cholangitis and/or liver abscess and multiple variables (age, disease, Child-Pugh class, size of nodules, multiplicity of nodules, history of transcatheter arterial embolization, presence of bilioenteric anastomosis, and lack of prophylactic antibiotics administration) were statistically analyzed. RESULTS: Cholangitis and/or liver abscess occurred in 10 sessions (1.5%) in 10 patients: six sessions after PEI, three sessions after PMC, and one session after RF ablation. Both cholangitis and liver abscess were noted in seven sessions, cholangitis was noted in two, and liver abscess was noted in one. Six patients recovered, but two developed recurrent cholangitis and liver abscess, one developed lung abscess complicated with liver abscess, and one died of septic shock associated with cholangitis. On stepwise regression analysis, bilioenteric anastomosis was the sole significant predictor of cholangitis and/or liver abscess formation (P <.001; odds ratio = 36.4; 95% CI = 9.67-136.9). CONCLUSION: Bilioenteric anastomosis strongly correlated with the development of cholangitis and/or liver abscess after percutaneous ablation therapy. Close posttreatment attention should be paid to this subgroup of patients.