This report discusses the pathophysiology of and therapeutic methods to address hepatic vein anastomotic
stricture after living donor
liver transplantation (LDLT). From 1994 to 2002, our 15 LDLTs using the lateral segments or left lobes included four recipients who experienced 28 occurrences of this complication after the operation. The period between LDLT and the first
stricture was 4.0 +/- 1.2 months. The age of the affected recipients (31.0 +/- 8.2 years) was significantly higher than that of the nonaffected patients (7.0 +/- 4.1 years, P < .05). Graft liver/standard liver volume ratio was 39.1% +/- 3.8% in the former and 77.9% +/- 12.7% in the latter cases (P < .05). Initial symptoms of
stricture were
ascites (42.9%), abdominal distention (42.9%), liver
enzyme elevation (10.7%), and gastrointestinal
bleeding (3.6%). In addition, 14 of 28
stricture cases (50%) showed increased blood trough levels of
tacrolimus. Doppler ultrasonography was used for diagnosis, and balloon dilatations performed in all
stricture patients, thereby hepatic significantly reducing venous blood pressure from 33.5 +/- 1.7 to 20.3 +/- 1.5 cmH2O. All patients finally resolved the
strictures after several treatments. The
stricture after LDLT was associated with small-for-size grafts, suggesting that liver regeneration may lead to anatomical changes and
strictures. Since
tacrolimus is metabolized by the liver, its blood trough level is one initial symptoms of
stricture. Balloon dilatation was useful and safe as the treatment, while problems have been reported after
stent insertion in the hepatic vein.