Outcomes of Percutaneous Treatment of Post-Transplant Portal Vein Stenosis

Purpose: Portal vein (PV) stenosis following liver transplant (LT), a rare complication, can result in portal hypertension or threaten transplant longevity via reduced perfusion. Treatment options include surgical revision or percutaneous transluminal angioplasty (PTA) or stent placement. This study describes outcomes of percutaneous management of post-LT PV stenosis.

Materials and Methods: Retrospective review of patients referred for percutaneous treatment of post-LT PV stenosis between 2015-2025 was performed. 18 patients (9M:9F; median age 55) were referred. Data collected included LT variables, percent PV stenosis, primary patency, anticoagulation (AC) use, and resolution of ascites. Outcomes were compared between PTA and stent groups

Results: PV stenosis was identified at a median of 160 days post-LT (11 asymptomatic stenosis with PV stenosis on post-LT surveillance imaging, 7 with ascites). Median percent stenosis was 64% (29-100%) with median minimal luminal diameter of 5mm (0-7.7mm). All 18 LT were performed with end-end PV-PV anastomosis. Two were repeat LTs and 2 were living related LT. 11 patients were on AC prior to intervention. Percutaneous trans-hepatic approach was used in 15, transjugular in 2, and tran-splenic in 1 index procedures. Technical success rate was 88.9% (16/18). Both failures occurred in 2 of the 3 patients with 100% PV stenosis. No complications occurred. Primary PTA was performed in 7 patients and primary stenting in 9 (5 self-expanding bare metal, 4 balloon expandable stent grafts). Median PTA diameter was 14mm (10-16mm) and median final stent diameter was 14mm (10-14mm, p >0.05). Median residual stenosis was 0% in both groups. 9 patients continued AC following index procedure while 2 initiated AC post-procedure. Symptomatic ascites completely resolved in 4/6 (66%) of patients who underwent successful index procedure. Median primary patency was 213 days for stents and 233 days for PTA (p >0.05). Rate of repeat intervention was not significantly different between groups (43% PTA vs 11% stent, p >0.05). Secondary patency was similar between groups (PTA 1435 days vs Stent 897 days, p >0.05). No patients required repeat transplant after successful index or repeat interventions.

Conclusion: Post-LT PV stenosis treated with PTA or stenting have similar median residual stenosis and primary patency rates. Technical failure occurred only in the setting of complete PV stenosis. Post-LT PV stenosis should be treated with either PTA or stent placement before reaching complete occlusion.