An Innovative Rescue Surgical Procedure for Early Onset Hepatic Venous Outflow Obstruction After Pediatric Living Donor Liver Transplantation

An Innovative Rescue Surgical Procedure for Early Onset Hepatic Venous Outflow Obstruction After Pediatric Living Donor Liver Transplantation

“…It is thus of utmost importance to develop techniques that salvage the graft. Our technique, in contrast to the one described by Chung et al, (1) avoids total vascular reclamping of the liver, thus avoiding further graft injury that could potentially lead to the need for re-LT. Vacuum-assisted…”

“…We read with great interest the article by Chung et al, which reported on the successful surgical rescue of an early onset hepatic venous outflow obstruction after pediatric living donor liver transplantation (LT). (1) Descriptions of procedures for hepatic vein thrombosis after LT in children are extremely uncommon, and an urgent re-LT is typically recommended. We herein share a previously unreported type of salvage procedure for this rare but severe complication.…”

The devil is in the detail: current management of perioperative surgical complications after liver transplantation

“…1). Common causes of HVOO include tight suture line, twisting of the anastomosis due to inappropriate graft positioning or regeneration, size discrepancy between graft and recipient vena cava, and perianastomotic fibrosis secondary to inflammation [2]. Diligent intraoperative technique to create a properly oriented, large outflow reconstruction helps to avoid HVOO.…”

“…In both adult and pediatric liver transplantation recipients who develop HVOO, it is reasonable to try percutaneous endovascular dilatation first, followed by stenting for refractory lesions. Finally, when minimally invasive techniques fail, surgical repair by cavoplasty [2] or retransplantation [7] may be necessary.…”