CURE OF SYMPTOMATIC PORTAL HYPERTENSION AFTER LIVER TRANSPLANTATION BY STENTING OF PORTAL VEIN STENOSIS

T Manière, L Bouchard, P Perreault, D Marleau, M Lafortune, G Pomier-Layrargues

Hôpital Saint-Luc du CHUM, Université de Montréal, Montréal, Québec

Post-operative vascular complications after liver transplantation usually involve hepatic artery. Stenosis of portal vein anastomosis may be observed but is rarely associated with clinical manifestations. We report the case of a 57 year old alcoholic cirrhotic patient who underwent uneventful liver transplantation without any technical problem for anastomosis of portal vein. Five months later, splenomegaly, ascites and perioesophageal collaterals were observed. One year after transplant, further increase in the size of the spleen and persistence of moderate ascites were noticed. Echo Doppler ultrasound demonstrated a stenosis on the portal trunk at the site of anastomosis with increase in mean velocity across the stenosis. Complete blood count showed 17´10⁹ WBC/L, 80´10⁹ platelets/L and hemoglobin of 80 g/L. Over the following 3 years, ascites has to be treated by spironolactone and furosemide. A liver biopsy did not show any evidence of cirrhosis. Upper GI endoscopy showed large size varices. A portography was performed by trans-hepatic approach. An important stenosis was demonstrated with a pressure gradient of 26 mmHg. The stenosis was dilated with a 12 mm angioplasty balloon catheter and a metallic stent was placed which induced a marked decrease of porto-portal gradient to 3mmHg. The clinical evolution was remarkable with disappearance of ascites and oesophageal varices; hypersplenism was markedly improved. The present case report demonstrates that portal vein stenosis might induce significant complications after liver transplantation which can be cured by transhepatic portal vein stenting.