Pathologic Correlation with Venographic and Hemodynamic Findings in Post-transplant Hepatic Venous Outflow Obstruction

Tuesday, March 7, 2023

4:21 PM – 4:30 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

AK

Ayca Z. Kutlu, MD (she/her/hers)

Honorary Research Fellow
University of Wisconsin Madison

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Sarvesh Periyasamy, PhD

Medical Student and Post-doctoral Researcher
University of Wisconsin School of Medicine and Public Health
JS

John F. Swietlik, MD

Assistant Professor
University of Wisconsin
Paul F. Laeseke, MD, PhD

Assistant Professor
University of Wisconsin
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Orhan Ozkan, MD

Chief, Vascular and Interventional Radiology
UW Hospital & Clinics

Disclosure(s):

Ayca Z. Kutlu, MD: No financial relationships to disclose

Sarvesh Periyasamy, PhD: Contrast Dynamics: Consultant (); HETPA Medical: Consultant (); Johnson and Johnson: Consultant (); Vector Surigcal: Consultant ()

Purpose: There is limited data on transjugular pressure measurements and venographic evaluation in post-transplant hepatic vein outflow obstruction (HVOO). The purpose of this study is to evaluate the correlation between venographic / hemodynamic findings and pathology in liver transplant patients.

Materials and Methods: Transjugular liver access interventions performed over a 13-year period in a single institution were retrospectively reviewed. Cases with TIPS, heart failure, and nodular regenerative hyperplasia were excluded. One hundred and ten patients who underwent transplant hepatic venography, hemodynamic assessment, and trans-catheter or percutaneous liver biopsies within 30 days of venographic/hemodynamic assessment were identified. Cases included 36 (32%) females, 74 (68%) males, mean age (range) 54(19-76). Surgical transplant history included piggyback anastomosis in all cases but one (end-to-end IVC anastomosis). Symptoms leading to transjugular pressure measurements and venography included elevated LFTs, persistent ascites, and pleural effusion. Venography reports stating the visual presence of significant stenosis/obstruction, and/or having a trans-anastomotic pressure gradient of >3 mm Hg was considered positive for HVOO. The presence of centrilobular (zone 3) sinusoidal dilatation and congestion in the absence of cardiac dysfunction or nodular regenerative hyperplasia was considered positive pathologic diagnosis for HVOO. Chi-squared test was used for statistical analysis.

Results: Of the 66 patients who had a negative venographic / hemodynamic evaluation, only one (1.5%) had positive and 65 (98.5%) had negative biopsy results. Forty-four patients were diagnosed with hepatic venous outflow obstruction with venography and pressure measurements. Of these, 14 (31.8%) had positive and 30 (68.2%) had negative biopsy results. There was a significant correlation between the venographic / hemodynamic evaluation and pathology results (p< 0.001).

Conclusion: Hemodynamic evaluation with venography had a significant correlation with pathology. However, positive findings on venography and pressure measurements were not always associated with positive biopsy results, possibly due to delayed development of pathologic findings.