Early Venous Outflow Obstruction After Liver Transplantation and Treatment With Cavo-Cavostomy

Quintela, José M.; Fernández, Constantino; Aguirrezabalaga, J.; Gerardo, Charles J.; Marini, Milagros; Suárez, Francisco; Gómez, Manuel

doi:10.1016/j.transproceed.2009.06.066

Cited by 12 publications

(19 citation statements)

References 9 publications

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“…2 However, revision of a cavocaval anastomosis is associated with a high rate of reoperative morbidity and mortality. 9 Endovascular strategies have been used in an attempt to minimize the inherent risk associated with reoperative operations. 3,7 And further advances have led to the development of the EKOS device, which uses ultrasound waveforms to achieve mechanical fractionation with simultaneous chemical thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

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Latchana

Jd²,

J³

et al. 2015

Exp Clin Transplant

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Inferior vena cava thrombosis is a rare occurrence after an orthotopic liver transplant that is associated with a high rate of retransplant and mortality. There is no consensus regarding the optimal therapeutic strategy. Surgical management, including thrombectomy with revision of the cavocaval anastomosis, has been described. With the use of endovascular therapies, several minimally invasive approaches are available that are effective and avoid the high morbidity associated with reoperative surgery. We describe our successful experience using an approach after a liver transplant in which the inferior vena cava thrombosis in a patient presenting with acute renal failure, anorexia, weight loss, and fatigue using an ultrasound-accelerated, catheter-directed thrombolysis platform in conjunction with systemic anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Untitled

Latchana

Jd²,

J³

et al. 2015

Exp Clin Transplant

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“…Vascular complications following to the technique of “piggyback” OLT has shown a low risk of venous outflow obstruction. Late hepatic vein obstruction is a rare complication, affecting less than 3% of OLT patients [10,11]. A contributing factor in the development of stenosis at the SHIVC anastomosis includes patients undergoing a retransplantation by excessive fibrous tissue [2,12].…”

Section: Discussionmentioning

confidence: 99%

Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation

2013

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Patient: Female, 54Final Diagnosis: Suprahepatic inferior vena cava anastomosis strictureSymptoms: Ascites • fatigue • lower limb edema • hepatomegalyMedication: —Clinical Procedure: —Specialty: Transplantology • Critical Care MedicineObjective:Unusual clinical courseBackground:Suprahepatic inferior vena cava anastomosis stricture is an unusual vascular complication after orthotopic liver transplantation with the “piggyback” technique. Clinical manifestations are dependent upon the severity of the stenosis. Portopulmonary hypertension after orthotopic liver transplantation is a complication that carries high mortality due to cardiopulmonary dysfunction. The pathogenesis of pulmonary vascular disorders after orthotopic liver transplantation remains uncertain.Case Report:We report a case of acute right heart pressure overload after surgical correction of the suprahepatic inferior vena cava anastomotic stricture in a 54-year-old woman who had preexisting pulmonary arterial hypertension associated with portal hypertension after orthotopic liver transplantation. Twenty months posttransplantation, she developed fatigue and progressive ascites. On admission, the patient had hepatomegaly, ascites, and lower limb edema. Symptoms in the patient developed gradually over time.Conclusions:Recurrent portal hypertension by vascular complications is a cause of pulmonary arterial hypertension after orthotopic liver transplantation. Clinical manifestations of suprahepatic inferior vena cava anastomotic stenosis are dependent upon their severity. Sildenafil is an effective drug for treatment of pulmonary arterial hyper-tension after portal hypertension by vascular complications.

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“…Outflow obstructions are some of the most serious complications after liver transplantation, and they occur more frequently with LDLT versus deceased donor liver transplantation because the anastomosis of the hepatic veins to the IVC is much narrower and more complicated than the anastomosis of the IVC to the IVC, and the liver graft is enlarged because of regeneration after transplantation 1, 26. Transplant surgeons have tried to prevent outflow obstructions in hepatic vein anastomoses by many procedures 6‐20…”

Section: Discussionmentioning

confidence: 99%

“…An outflow obstruction of the hepatic vein is a critical complication after liver transplantation 1. Once it occurs, the liver graft is impaired by congestion, which results in jaundice, massive ascites, coagulopathy, and occasionally hepatic failure.…”

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confidence: 99%

Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation

et al. 2012

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An outflow obstruction of the hepatic vein is a critical complication after living donor liver transplantation (LDLT) and occasionally leads to hepatic failure. Here we introduce a simple method for preventing outflow obstructions by patch plasty in adult LDLT. Between September 2001 and May 2010, 468 adult LDLT procedures were performed at Kyoto University Hospital. We harvested each recipient's portal vein (PV) from the extirpated liver for a patch. We intended to re-form several orifices of the hepatic veins into a single, large orifice. The patch was attached to the anterior wall of the re-formed orifice on the bench. After we put in the liver graft, the procedure for the hepatic vein anastomosis to the inferior vena cava was simple enough that the warm ischemia time was reduced. Three of the 468 cases were diagnosed with an outflow obstruction. All 3 cases underwent hepatic vein reconstruction without patch plasty. In contrast, none of the 159 cases that underwent LDLT with patch plasty suffered from an outflow obstruction, regardless of the liver graft type. The procedure for hepatic vein plasty using a patch from the native PV is simple and elegant and results in excellent outcomes. We propose this as the standard procedure for hepatic vein reconstruction in adult LDLT.

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Early Venous Outflow Obstruction After Liver Transplantation and Treatment With Cavo-Cavostomy

Cited by 12 publications

References 9 publications

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Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation

Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation

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