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de Santibanes M, Ardiles V, Uño JW, Mattera J, de Santibanes E, Pekolj J. Surgical strategies to treat portal vein thrombosis during adult liver transplantation. Langenbecks Arch Surg 2023; 408:399. [PMID: 37831179 DOI: 10.1007/s00423-023-03141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The incidence of portal vein thrombosis (PVT) at the time of liver transplantation (LT) may be variable and underestimated. Therefore, preoperative diagnosis and stratification of its extension is so relevant for adequate surgical planning. Revascularization of the portal vein graft becomes essential for graft and patient survival after LT. Early stages of PVT may be managed with eversion thrombectomy and end-to-end anastomoses. However, severe PVT (grades 3 and 4) poses significant challenges for patients requiring LT, resulting in more complex surgeries and higher complication rates. To address these complexities, various surgical techniques have been developed, including collateral alternative vessel utilization, renoportal anastomoses, mesoportal jump graft placement, cavoportal hemitranspositions, portal vein arterialization, or even multivisceral transplantation. PURPOSE We herein describe the preoperative surgical planning as well as the different surgical strategies possible to treat portal vein thrombosis during LT. CONCLUSION A comprehensive preoperative evaluation of PVT is crucial for accurately assessing its extent and severity. This information is vital for proper surgical planning, which ultimately prepares both the surgeon and the patient for potentially complex procedures during LT. The surgical alternatives presented in this technical report offer promising solutions for treating PVT during LT, making it a viable option for selected patients.
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Affiliation(s)
- Martin de Santibanes
- Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190. C1181ACH, Buenos Aires, Argentina.
| | - Victoria Ardiles
- Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190. C1181ACH, Buenos Aires, Argentina
| | - Jimmy Walker Uño
- Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190. C1181ACH, Buenos Aires, Argentina
| | - Juan Mattera
- Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190. C1181ACH, Buenos Aires, Argentina
| | - Eduardo de Santibanes
- Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190. C1181ACH, Buenos Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190. C1181ACH, Buenos Aires, Argentina
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Ghibes P, Grözinger G, Hartleif S, Sturm E, Hefferman GM, Nadalin S, Tsiflikas I, Schäfer JF, Artzner C. Balloon angioplasty versus stent placement for the treatment of portal vein stenosis in children: a single center experience. Pediatr Radiol 2023; 53:1885-1893. [PMID: 37147428 DOI: 10.1007/s00247-023-05674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous interventional treatment of portal vein stenosis in children. MATERIAL AND METHODS A retrospective analysis of all interventional treatments for portal vein stenosis in pediatric patients at a single institution from 2010 to 2021 was conducted. Platelet count, spleen size and portal vein flow velocity were assessed during the follow-up period. Primary and primary assisted patency time were determined. RESULTS A total of ten children (median age 28.5 months, interquartile range (IQR): 2.75-52.5 months) with portal vein stenosis after Mesorex-Shunt (n = 4), liver transplantation (n = 3) and other etiologies (n = 3) underwent 15 interventional procedures. There were five reinterventions and one discontinued intervention. The technical success rate was 93.3% (14/15) and clinical success of treated patients was 100% (14/14). Median follow-up was 18 months (IQR: 13.5-81 months). The median primary patency time for stent placement was 70 months (IQR: 13.5-127.25 months). For balloon angioplasty, the median primary patency time was 9 months (IQR 7.25-11.5 months), while the median assisted primary patency time was 14 months (IQR: 12 to 15 months). Platelet count, spleen size and portal vein flow velocity reliably corresponded to recurrence of portal vein stenosis in asymptomatic patients during follow-up. CONCLUSION Interventional treatment is a safe and efficient method to treat portal vein stenosis with long patency times, regardless of etiology. Primary stent placement shows a higher primary patency time than balloon angioplasty. Implementation of stent placement as the primary interventional method may improve patency times and reduce the need for repeat reinterventions in pediatric patients.
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Affiliation(s)
- Patrick Ghibes
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany.
| | - Gerd Grözinger
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany
| | - Steffen Hartleif
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Ekkehard Sturm
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Gerald M Hefferman
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Ilias Tsiflikas
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany
| | - Jürgen F Schäfer
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany
| | - Christoph Artzner
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Staße 3, 72076, Tuebingen, Germany
- Department of Radiology, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
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Venuthurimilli AK, Gupta R, Singhal S, Madaan V, Kumar P, Singh A, Sah R, Rastogi H, Vohra S, Sahni R, Bharadwaj R, Kumar K, Malhotra S, Jerat N, Sibal A, Goyal N. Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant. Pediatr Transplant 2023; 27:e14427. [PMID: 36324265 DOI: 10.1111/petr.14427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. MATERIALS AND METHODS From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed. RESULTS Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications. CONCLUSION Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.
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Affiliation(s)
- Arun Kumar Venuthurimilli
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Rigved Gupta
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Saurabh Singhal
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Varun Madaan
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Pradeep Kumar
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Akanand Singh
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Rambabu Sah
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Harsh Rastogi
- Department of Interventional Radiology, Indraprastha Apollo Hospital, New Delhi
| | - Sandeep Vohra
- Department of Radio-diagnosis, Indraprastha Apollo Hospitals, New Delhi, India
| | - Reeti Sahni
- Department of Radio-diagnosis, Indraprastha Apollo Hospitals, New Delhi, India
| | - Ravi Bharadwaj
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Karunesh Kumar
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Smita Malhotra
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Namit Jerat
- Department of Pediatric Intensive Care, New Delhi, India
| | - Anupam Sibal
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Neerav Goyal
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
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Portal vein obstruction after pediatric liver transplantation: A systematic review of current treatment strategies. Transplant Rev (Orlando) 2021; 35:100630. [PMID: 34107368 DOI: 10.1016/j.trre.2021.100630] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Portal vein obstruction (PVO) is a significant vascular complication after liver transplantation (LT) in pediatric patients. Current treatment strategies include percutaneous transluminal angioplasty (PTA), with or without stent placement, mesorex bypass (MRB), splenorenal shunt, mesocaval shunt, endovascular recanalization (EVR), splenic artery embolization and splenectomy. However, specific characteristics of patients undergoing intervention and selection of individual treatment and its efficacy have remained unclear. This review systematically analyzed biochemical and clinical characteristics, selection of treatment, efficacy, and post-procedural complications. METHODS We systematically searched PubMed and Embase between January 1995 and March 2021 for studies on the management of PVO after LT. We analyzed the reports for biochemical and clinical characteristics at the timing of the intervention in different patients, selection of treatment, and reported efficacies. RESULTS We found 22 cohort studies with 362 patients who had the following characteristics: biliary atresia (83%), living-donor LT (85%), thrombocytopenia (73%), splenomegaly (40%), ascites (16%), or gastrointestinal bleeding (26%). The 3-year primary patency of PTA without stent placement was similar to that with stent placement (70%-80% and 43%-94%, respectively). MRB was used as an initial treatment with a 3-year patency of 75% to 100%. One study showed that 5-year primary patency of EVR was 80%. Secondary patency was 90% to 100% after 3 years in all studies with PTA alone, PTA/stent placement, and stent placement alone. CONCLUSION This is the first review of all treatment protocols in PVO after pediatric LT. We showed that an important group of patients has severe symptoms of portal hypertension. Efficacy of all treatment modalities was high in the included studies which make them important modalities for these patients.
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Ko GY, Sung KB, Gwon DI. The Application of Interventional Radiology in Living-Donor Liver Transplantation. Korean J Radiol 2021; 22:1110-1123. [PMID: 33739630 PMCID: PMC8236365 DOI: 10.3348/kjr.2020.0718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 11/14/2020] [Indexed: 01/10/2023] Open
Abstract
Owing to improvements in surgical techniques and medical care, living-donor liver transplantation has become an established treatment modality in patients with end-stage liver disease. However, various vascular or non-vascular complications may occur during or after transplantation. Herein, we review how interventional radiologic techniques can be used to treat these complications.
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Affiliation(s)
- Gi Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Kyu Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Uchida H, Sakamoto S, Shimizu S, Takeda M, Yanagi Y, Fukuda A, Abdelwahed MS, Miyazaki O, Nosaka S, Kasahara M. Efficacy of intraoperative cine-portogram for complicated portal vein reconstruction in pediatric living donor liver transplantation. Pediatr Transplant 2021; 25:e13835. [PMID: 32886397 DOI: 10.1111/petr.13835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/01/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
Sufficient PV flow is necessary to achieve successful PV reconstruction in pediatric LDLT. IOCP can be used to assess the severity of PV stenosis and to identify potential portosystemic collateral pathways. The present study reviewed the utility of IOCP and the outcomes of patients who underwent assessment with an IOCP. Consecutive primary LDLTs were performed in 488 pediatric recipients between November 2005 and October 2019. IOCP was used in patients who were unable to achieve sufficient PV flow after the ligation of collaterals. In total, 11 patients underwent IOCP to assess potential portosystemic collateral pathways. The median age and body weight was 8 months (IQR, 6-11 months) and 6.6 kg (IQR, 5.7-8.9 kg), respectively. The reasons for using the IOCP were recurrent PV thrombus in seven patients and insufficient PV flow in four patients. IOCP revealed remaining collaterals in six patients and residual hypoplastic PV in eight patients. Two patients required additional interruption of the potential collaterals under IOCP, which were unable to be recognized as a dominant portosystemic collateral pathway on preoperative imaging. All eight patients with residual hypoplastic PV required vein graft interposition for the complete removal of the hypoplastic PV. All the patients are currently doing well with a median follow-up period of 4.9 years (IQR, 2.2-5.6 years). IOCP can be an effective tool for precisely detecting occult portosystemic collateral pathways and for assessing the patency of the PV anastomosis in pediatric LDLT.
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Affiliation(s)
- Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seiichi Shimizu
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masahiro Takeda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yusuke Yanagi
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mohamed Sami Abdelwahed
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Miyazaki
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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Anand K, Garza L, Halff G, Klair T, Cigarroa F, Suri R, Lopera J. Direct transmesenteric venous interventions in the acute post liver transplant setting. J Interv Med 2021; 4:46-48. [PMID: 34805947 PMCID: PMC8562253 DOI: 10.1016/j.jimed.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Portal venous thrombosis and stenosis are uncommon but serious causes of liver transplant graft failure. While surgical thrombectomy can be utilized for the treatment of portal steno-occlusive disease, venous interventions with IR have been performed with encouraging results. CASE DESCRIPTION 69-year-old female with non-alcoholic steatohepatitis cirrhosis who received a liver transplant complicated by portal vein thrombus. Efforts between transplant surgery and IR allowed for successful thrombus removal via direct SMV access. RESULTS The advantages of direct SMV access with the surgery team include direct approach to accessing thrombus, sparing of liver parenchyma, and significant hemostatic control.
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Affiliation(s)
- Keshav Anand
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Luis Garza
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Glenn Halff
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Tarunjeet Klair
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Francisco Cigarroa
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Rajeev Suri
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Jorge Lopera
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
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Grimaldi C, Spada M, Maggiore G. Liver Transplantation in Children: An Overview of Organ Allocation and Surgical Management. Curr Pediatr Rev 2021; 17:245-252. [PMID: 34086551 DOI: 10.2174/1573396317666210604111538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/22/2022]
Abstract
Liver transplantation is the standard treatment for children with end-stage liver disease, primary hepatic neoplasms, or liver-localized metabolic defects. Perioperative mortality is almost absent, and long-term survival exceeds 90%. Organ shortage is managed thanks to advances in organ retrieval techniques; living donation and partial liver transplantation almost eliminated waiting list mortality, thus leading to expanding indications for transplantation. The success of pediatric liver transplantation depends on the prompt and early referral of patients to transplant Centers and on the close and integrated multidisciplinary collaboration between pediatricians, hepatologists, surgeons, intensivists, oncologists, pathologists, coordinating nurses, psychologists, and social workers.
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Affiliation(s)
- Chiara Grimaldi
- Hepatobiliopancreatic and Abdominal Transplant Surgery, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
| | - Marco Spada
- Hepatobiliopancreatic and Abdominal Transplant Surgery, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
| | - Giuseppe Maggiore
- Hepatogastroenterology and Nutrition, IRCCS Bambino Gesù Pediatric Hospital, Rome,Italy
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Khan A, Kleive D, Aandahl EM, Fosby B, Line PD, Dorenberg E, Guvåg S, Labori KJ. Portal vein stent placement after hepatobiliary and pancreatic surgery. Langenbecks Arch Surg 2020; 405:657-664. [PMID: 32621087 PMCID: PMC7449988 DOI: 10.1007/s00423-020-01917-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Abstract
Purpose To evaluate the long-term outcomes of percutaneous transhepatic stent placement for portal vein (PV) stenosis after liver transplantation (LT) and hepato-pancreato-biliary (HPB) surgery. Methods Retrospective study of 455 patients who underwent LT and 522 patients who underwent resection of the pancreatic head between June 2011 and February 2016. Technical success, clinical success, patency, and complications were evaluated for both groups. Results A total of 23 patients were confirmed to have postoperative PV stenosis and were treated with percutaneous transhepatic PV stent placement. The technical success rate was 100%, the clinical success rate was 80%, and the long-term stent patency was 91.3% for the entire study population. Two procedure-related hemorrhages and two early stent thromboses occurred in the HPB group while no complications occurred in the LT group. A literature review of selected studies reporting PV stent placement for the treatment of PV stenosis after HPB surgery and LT showed a technical success rate of 78–100%, a clinical success rate of 72–100%, and a long-term patency of 57–100%, whereas the procedure-related complication rate varied from 0–33.3%. Conclusions Percutaneous transhepatic PV stent is a safe and effective treatment for postoperative PV stenosis/occlusion in patients undergoing LT regardless of symptoms. Due to increased risk of complications, the indication for percutaneous PV stent placement after HPB surgery should be limited to patients with clinical symptoms after an individual assessment.
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Affiliation(s)
- Ammar Khan
- Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Dyre Kleive
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Einar Martin Aandahl
- Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Bjarte Fosby
- Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eric Dorenberg
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Steinar Guvåg
- Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Knut Jørgen Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
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