Portal Vein Stenosis Management in the Long-Term After Living Donor Liver Transplant.

Objectives: Portal vein stenosis occasionally occurs as a postoperative complication of a living donor liver transplant. Portal vein stenosis decreases the portal venous blood supply to the liver graft and increases extrahepatic portal venous pressure, which may lead to liver dysfunction, splenomegaly, gastrointestinal bleeding, cytopenia, and ascites.

Materials and methods: From November 2021 to February 2024, we treated 6 patients at our center who presented with clinical features of bilirubinemia and signs of portal hypertension (cytopenia, ascites) that occurred in the long-term after liver transplant. In all cases, portal vein stenosis was diagnosed by ultrasonography and contrast-enhanced computed tomography. The results of endovascular interventions on the portal vein were assessed.

Results: All patients were treated with percutaneous transhepatic correction of portal vein stenosis with balloon venoplasty. In all cases, an ultrasonography guided percutaneous approach to the portal vein was performed. Balloon venoplasty was performed in all cases, and no stents were used. No postoperative complications occurred. Signs of portal hypertension and graft dysfunction regressed after an average of 1 month of observation. There were no recurrences during 15 months of follow-up.

Conclusions: Our case series highlighted the importance of considering portal vein stenosis in the differential diagnosis of late-onset portal hypertension or liver graft dysfunction symptoms following liver transplant. The optimal treatment method is endovascular intervention.