Two-year outcomes of balloon-occluded retrograde transvenous obliteration of gastric varices in liver transplant recipients: A multi-institutional study

W E Saad; J F B Chick; R N Srinivasa; N Saad; S Kim; A Fischman; G Frey; A Al-Osaimi; S Caldwell

doi:10.1016/j.diii.2017.03.005

Two-year outcomes of balloon-occluded retrograde transvenous obliteration of gastric varices in liver transplant recipients: A multi-institutional study

Diagn Interv Imaging. 2017 Nov;98(11):801-808. doi: 10.1016/j.diii.2017.03.005. Epub 2017 Apr 14.

Authors

W E Saad¹, J F B Chick², R N Srinivasa¹, N Saad³, S Kim³, A Fischman⁴, G Frey⁵, A Al-Osaimi⁶, S Caldwell⁶

Affiliations

¹ Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Michigan Medicine, 1500, East Medical Center Drive, 48109 Ann Arbor, Michigan, USA.
² Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Michigan Medicine, 1500, East Medical Center Drive, 48109 Ann Arbor, Michigan, USA. Electronic address: jeffreychick@gmail.com.
³ Department of Radiology, Division of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, 63110 Saint-Louis, MO, USA.
⁴ Department of Radiology, Division of Vascular and Interventional Radiology, Mount Sinai Hospital, 10029 New York, NY, USA.
⁵ Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, 55902 Rochester, MN, USA.
⁶ Department of Radiology, Division of Vascular and Interventional Radiology, University of Virginia Health System, 22908 Charlottesville, VA, USA.

PMID: 28416166
DOI: 10.1016/j.diii.2017.03.005

Abstract

Purpose: To assess the 2-year effectiveness and safety of balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices (GV_s) in liver transplant recipients.

Materials and methods: Eleven liver transplant recipients underwent consecutive BRTO for GV_s at four institutions. Patients included eight (73%) men and three (27%) women with mean age of 56 years±12 (SD) (range: 26-67 years). Underlying cause of liver transplantation was hepatitis C virus (HCV)-related cirrhosis in five (45%), alcohol- and HCV-related cirrhosis in three (27%), primary biliary cirrhosis in two (18%), and alcoholic cirrhosis in one (9%). Five (45%) patients underwent BRTO for actively bleeding GV_s, three (17%) for high-risk GV_s, and three (17%) for augmentation of portal venous flow through obliteration of gastrorenal shunts. Mean time between liver transplantation and BRTO was 78 months (range: 0.1-276 months). Technical success, GV_s obliterative rates, and immediate complications were recorded. Post-BRTO hemorrhagic, transplant, and overall survival rates were evaluated at 6, 12, and 24 months.

Results: All (100%) procedures were technically successful. Complete GV_s obliteration was achieved in ten patients (91%). Two major complications (18%) occurred in the immediate post-procedure period. One patient developed complete portal vein thrombosis, and another patient developed consumptive coagulopathy, ultimately leading to death. No post-BRTO hemorrhagic recurrences were seen at 6, 12, or 24 months. One patient (9%) had delayed upper gastrointestinal bleeding at 34 months after the procedure which was managed conservatively. Transplant and overall survival rates were 91% at 6, 12, and 24 months.

Conclusion: BRTO has high technical success and complete GV_s obliterative rates in liver transplant recipients with few complications and high graft survival rates.

Keywords: Balloon-occluded retrograde transvenous obliteration; Gastric varices; Interventional radiology; Liver transplant recipient; Liver transplantation.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Balloon Occlusion* / adverse effects
Esophageal and Gastric Varices / complications
Esophageal and Gastric Varices / therapy*
Female
Gastrointestinal Hemorrhage / etiology
Gastrointestinal Hemorrhage / therapy*
Humans
Liver Transplantation*
Male
Middle Aged
Transplant Recipients