173 - Percutaneous Portal Venous Stent Placement for Post-Transplant Portal Vein Stenosis: Technical and Clinical Outcomes from a Single-Center Experience

Purpose: Portal vein (PV) stenosis and thrombosis are major vascular complications after liver transplantation. If left untreated, it leads to portal hypertension (PoHTN), graft dysfunction/failure{1,2}. This study evaluated the technical success, patency, and clinical outcomes of percutaneous PV stent placement in liver transplant recipients with PV stenosis/occlusion.

Materials and Methods: This retrospective study included 15 post-liver transplant patients (mean age 51.7 ± 17.9 years; 10 males) who underwent percutaneous PV stent placement. All patients presented with at least 1 clinical manifestation of PoHTN (ascites, abnormal liver enzymes, variceal bleeding) along with imaging evidence of significant PV stenosis/occlusion (≥50% luminal narrowing, flow acceleration at anastomosis, or post-anastomotic jet), confirmed on direct portography. Pre- and post-stent PV pressure gradients (PVPG) and adverse events were documented. Technical success (successful stent deployment with restoration of hepatopetal flow) and clinical success (resolution of PoHTN-related signs and normalization of liver function) were noted. Patency was assessed at 1, 3, 6, and 12-months.

Results: Technical success was reported in all patients (100%). Stent sizes ranged from 8-14 mm (median = 10, IQR = 10-12). Direct portogram showed PV thrombosis requiring thrombectomy in 2/15 patients (13.3%). Clinical success was reported in all patients (100%), with improvement in MELD scores reported in 13/15 (86.7%) patients at 1-month follow-up.

Mean pre- and post-stent PVPG was 7.75 ± 4.6 mmHg and 1.1 ± 1.4 mmHg (p=0.0002). The mean PVPG decrease post-stent placement was 6.7 ± 4.1 mmHg. No intraprocedural adverse events were reported. One late complication, a hepatic artery pseudoaneurysm at 4 months, was managed with coil embolization. Stent patency was 93.3% at 1 month (14/15), with 1 restenosis requiring reintervention. At 3, 6, and 12 months, stent patency was 100% (including patient with secondary venoplasty). Changes in lab values are shown in Table 1. One-year survival was 100%.

Conclusion: Percutaneous PV stent placement is a safe, effective, and durable option for the management of portal hypertension in liver transplant recipients. PV stent placement demonstrated high technical & clinical success, and sustained patency.