Inferior Vena Cava Constriction After Liver Transplantation Is a Severe Complication Requiring Individually Adapted Treatment: Report of a Single-Center Experience

Abstract

Background Reports on vena cava occlusion after liver transplantation (LT) are rare, but this finding represents a severe complication in the early postoperative period. In the context of the complex presentation of a patient after LT, symptoms are often misinterpreted and can be subtle. Material/Methods In our cohort of 138 LTs performed between 2014 and 2017 at our University’s Transplantation Department, 117 transplantations were valid for further analysis after exclusion of pediatric transplantations and transplants with primary non-function grafts. In 101 cases (73%), patients received a deceased-donor full-size organ. Living-donor LT was performed in 8 patients (6.4%) and 8 patients (6.4%) received a split graft. We report on 6 patients who had inferior vena cava (IVC) occlusion and summarize the treatment choices. Results In our series, patients with positive findings (age 38–70 years) received an orthotopic full-size deceased-donor graft with end-to-end IVC anastomosis. In the subsequent period, imaging revealing IVC occlusion was done on a follow-up basis (n=2), due to dyspnea (n=1), and for progressive ascites (n=2). In 3 cases, a thrombus was found. We give detailed information on our treatment options from interventional treatment to transcardial thrombus removal and anastomosis augmentation. Conclusions IVC constriction and subsequent thrombosis are severe complications after LT that require individually adapted treatment in specialized centers. Since patients often present with subclinical symptoms, vascular diagnosis should be performed early to detect caval anastomosis pathologies. Despite regular ultrasonography, we favor CT and cavography for subsequent quantification. We also review the literature on IVC occlusion after LT.

Severe Outflow Obstruction After Liver Transplantation: Rescue Stapled Cavo‐Cavostomy via the Right Atrial Approach and Hypothermic Circulatory Arrest

“…Systemic reviews of interventional versus surgical treatment options, especially of late complications in adults, are lacking. (4) We have described a hybrid of previous techniques used at our institution that allowed us to simultaneously reopen the strictured sections of the piggyback site and the IVC while avoiding the abdominal cavity and prior operative field. Deep circulatory arrest allowed for maximal control of bleeding and direct visualization of the stenosis.…”

Indication of Liver Transplantation for Hepatocellular Carcinoma Should Be Reconsidered in Case of Microvascular Invasion and Multilocular Tumor Occurrence

“…The date of the last follow-up and possible tumor recurrence as well as tumor-related or independent death during the study were recorded. LT procedures were published before [ 16 ]. All explants were examined macroscopically and histologically by board certified surgical pathologists.…”

Diagnostic and Interventional Radiology in the Management of Post–Liver Transplant Vascular Complications

“…Late stenosis is more common and is most often due to perivascular fibrosis or intimal hyperplasia but may also result from compression or twisting of a growing split graft. 33 Clinical manifestations of venous outflow obstruction at the HV or the IVC, above the HV anastomosis, involve symptoms of hepatic congestion including ascites, varices, hepatosplenomegaly, pleural effusions, abdominal pain, and abnormal LFTs. With IVC stenosis below the HV anastomosis, lower limb edema or ascites may be the presenting symptoms.…”

“…Unfortunately, immediate postprocedure thrombosis often requires retransplantation. 33 in transplant recipients. Diagnostic and interventional radiology play a fundamental role in the identification and management of these conditions.…”

“…Late stenosis is more common and is most often due to perivascular fibrosis or intimal hyperplasia but may also result from compression or twisting of a growing split graft. 33…”