DAMİANO PATRONO, SİLVİA MAROLA, EZİO DAVİD, LUİGİ CHİUSA, SİLVİA MARTİNİ, STEFANO MİRABELLA, FRANCESCO LUPO, MAURO SALİZZONİ, RENATO ROMAGNOLİ
Experimental and Clinical Transplantation - 2019;17(2):214-221
Objectives: Veno-occlusive disease after liver trans - plant has been sporadically reported, and significant uncertainty exists concerning the best treatment and the long-term outcomes. Here, we reviewed our experience to evaluate clinical presentation, treat - ment, and the long-term outcomes of these patients. Materials and Methods: Between 2000 and 2015, 2165 patients underwent liver transplant at our center. The incidence of veno-occlusive disease was 0.3% (7/2165). Results: Timing of veno-occlusive disease onset (median 4.7 mo; interquartile range, 2.5-11.1 mo) varied widely as did clinical presentation, which was characterized by a variable association of liver failure and portal hypertension and different disease pro - gression rates. In all cases, diagnosis of veno-occlusive disease was confirmed by liver biopsy. Six patients (85.7%) presented with veno-occlusive disease after a previous episode of acute cellular rejection. Three patients died due to veno-occlusive disease (n = 2) or due to hepatocellular carcinoma recurrence (n = 1). Two patients were treated by increasing immunosup pression and with interventional pro - cedures (pleurodesis and transjugular intrahepatic portosystemic shunt, respectively), and 2 had successful retransplants. 5-year patient and graft survival rates were 57.1% and 28.6%, respectively. Conclusions: A tailored approach based on clinical features and including retransplant can achieve acceptable long-term survival in patients with venoocclusive disease after liver transplant.
