Primary Gianturco stent placement for inferior vena cava abnormalities following liver transplantation

PURPOSE: To determine the efficacy of primary Gianturco stent placement for patients with inferior vena caval (IVC) abnormalities following liver tran splantation. MATERIALS AND METHODS: From August 1996 through March 1999, nine adult pati ents developed significant IVC abnormalities following liver transplantatio n. Patients were referred for vena cavography on the basis of abnormal clin ical findings, laboratory values, liver biopsy results, Doppler findings, o r a combination. Those patients demonstrating a significant caval or hepati c venous gradient were treated with primary Gianturco stent placement. Pati ents were followed clinically (nine patients), with duplex ultrasound (nine patients), vena cavography (four patients), and biopsy (seven patients), RESULTS: Original pressure gradients ranged from 3 to 14 mm Hg, with a mean of 9 mm Hg. Gradients were reduced to 3 mm Hg or less in all nine patients ; presenting signs and symptoms either resolved or improved in eight of nin e patients, The ninth patient required repeated transplantation 2 days late r. A second patient died 433 days after stent placement of recurrent hepati tis C, Another initially improved following caval stent placement, but unde rwent repeated transplantation 7 days later due to hepatic necrosis from he patic arterial thrombosis. Follow-up for the remaining six patients has ave raged 491 days, with no clinical, venographic, or ultrasound evidence for r ecurrent caval stenosis. CONCLUSIONS: Intermediate term results suggest that primary Gianturco stent placement for IVC stenosis, compression, or torsion resulting after liver transplantation is safe and effective.