| Institution: | 1. Division of Interventional Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;2. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;1. Vanderbilt University School of Medicine, Nashville, Tennessee;2. Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee;3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee;4. Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee;5. Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee;1. Department of Radiology, Kaiser Permanente Oakland Medical Center, Oakland, California;2. Department of Radiology, Kaiser Permanente Richmond Medical Center, Richmond, California;3. Department of Psychology, George Mason University, Fairfax, Virginia;1. Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;2. Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin;3. Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania;4. Division of Vascular and Interventional Radiology, Department of Radiology, University of California San Diego, La Jolla, California;1. Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee;2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee;3. Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee;4. Division of Interventional Radiology, Vanderbilt University Medical Center, Nashville, Tennessee;5. Division of Interventional Radiology, Stanford University, Palo Alto, California;6. Department of Radiation Oncology, Sarah Cannon Research Institute, Nashville, Tennessee;7. Division of Interventional Radiology, Miami Cardiac and Vascular Institute/Miami Cancer Institute, Miami, Florida;8. Division of Interventional Radiology, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina;9. Division of Interventional Radiology, University of Kansas, Kansas City, Kansas;10. Division of Interventional Radiology and Image-Guided Therapy, Emory University School of Medicine, Atlanta, Georgia;11. Division of Interventional Radiology, Christiana Medical Center, Newark, Delaware;12. Division of Interventional Radiology, Carolinas Medical Center, Charlotte, North Carolina;13. Division of Interventional Radiology, Radiology Associates of Florida, Tampa, Florida;1. Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;2. Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy |
| Abstract: | PurposeTo investigate the effectiveness of plug-assisted retrograde transvenous obliteration (PARTO) for portal steal from complicated portosystemic shunts (PSSs) in living-donor liver transplantation (LDLT).Materials and MethodsThis retrospective study included consecutive patients who underwent LDLT and intraoperative or postoperative PARTO for complicated PSS between January 2020 and December 2021. PARTO was performed when hepatofugal portal flow steal was identified during intraoperative cineportography, and afferent vein embolization was difficult because of multiple afferent veins or incomplete afferent vein embolization. Liver volume, complete obliteration of PSS, technical success, adverse events, and follow-up clinical and laboratory data were evaluated.ResultsThirty-seven patients were included, and the technical success rate was 100% with no major adverse events. During the median follow-up of 20.0 months, all patients recovered well with suitable regeneration of the liver without graft dysfunction related to a portal steal. The liver volume significantly increased within 1 month (median, 956 vs 1,198 mL; P < .001). Complete obliteration of a PSS occurred in 36 of 37 (97.3%) patients, and there was no recurrence during follow-up. The Child-Pugh score, serum albumin and total bilirubin levels, and prothrombin time showed significant improvement over serial follow-up. Compared with preprocedural values (14.9 cm/s), follow-up portal flow (median) peaked on the first day (71.2 cm/s, P < .001) and then remained significantly high at 1 week (60.3 cm/s, P < .001) and 1 month (53.1 cm/s, P < .001), in accordance with the graft regeneration.ConclusionsPARTO is an effective procedure for the treatment of complicated PSS in LDLT. |
