Therapeutic efficacy and stent patency of transhepatic portal vein stenting after surgery

AIM To evaluate portal vein(PV) stenosis and stent patency after hepatobiliary and pancreatic surgery, using abdominal computed tomography(CT).METHODS Percutaneous portal venous stenting was attempted in 22 patients with significant PV stenosis(> 50%)-after hepatobiliary or pancreatic surgery- diagnosed by abdominal CT. Stents were placed in various stenotic lesions after percutaneous transhepatic portography. Pressure gradient across the stenotic segment was measured in 14 patients. Stents were placed when the pressure gradient across the stenotic segment was > 5 mm Hg or PV stenosis was > 50%, as observed on transhepatic portography. Patients underwent followup abdominal CT and technical and clinical success, complications, and stent patency were evaluated.RESULTS Stent placement was successful in 21 patients(technical success rate: 95.5%). Stents were positioned through the main PV and superior mesenteric vein(n = 13), main PV(n = 2), right and main PV(n = 1), left and main PV(n = 4), or main PV and splenic vein(n = 1). Patients showed no complications after stent placement. The time between procedure and final follow-up CT was 41-761 d(mean: 374.5 d). Twenty stents remained patent during the entire follow-up. Stent obstruction-caused by invasion of the PV stent by a recurrent tumor- was observed in 1 patient in a follow-up CT performed after 155 d after the procedure. The cumulative stent patency rate was 95.7%. Small in-stent low-density areas were found in 11(55%) patients; however, during successive follow-up CT, the extent of these areas had decreased.CONCLUSION Percutaneous transhepatic stent placement can be safe and effective in cases of PV stenosis after hepatobiliary and pancreatic surgery. Stents show excellent patency in follow-up abdominal CT, despite development of small in-stent low-density areas.

New-onset diabetes after adult liver transplantation in the Korean Organ Transplantation Registry (KOTRY) study

Background:New-onset diabetes after transplantation(NODAT)is a serious complication following liver transplantation(LT).The present study aimed to investigate the incidence of and risk factors for NODAT using the Korean Organ Transplantation Registry(KOTRY)database.Methods:Patients with history of pediatric transplantation(age≤18 years),re-transplantation,multi-organ transplantation,or pre-existing diabetes mellitus were excluded.A total of 1,919 non-diabetic adult patients who underwent a primary LT between May 2014 and December 2017 were included.Risk factors were identified using Cox regression analysis.Results:NODAT occurred in 19.7%(n=377)of adult liver transplant recipients.Multivariate analysis showed steroid use,increased age,and high body mass index(BMI)in recipients,and implantation of a left-side liver graft was closely associated with NODAT in adult LT.In living donor liver transplant(LDLT)patients(n=1,473),open donor hepatectomy in the living donors,steroid use,small for size liver graft(graft to recipient weight ratio≤0.8),increased age,and high BMI in the recipient were predictive factors for NODAT.The use of antimetabolite and basiliximab induction reduced the incidence of NODAT in adult LT and in adult LDLT.Conclusions:Basiliximab induction,early steroid withdrawal,and antimetabolite therapy may prevent NODAT after adult LT.High BMI or advanced age in liver recipients,open donor hepatectomy in living donors,and small size liver graft can predict the occurrence of NODAT after adult LT or LDLT.