Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):321-325. 10.14701/ahbps.2018.22.4.321.

Hepatic venous outflow obstruction after whole liver transplantation of large-for-size graft: versatile intra-operative management

• Lim C
• Osseis M
• Tudisco A
• Lahat E
• Sotirov D
• Salloum C
• Azoulay D

• KMID: 2427362
• DOI: http://doi.org/10.14701/ahbps.2018.22.4.321

Abstract

BACKGROUNDS/AIMS
Preservation of the native inferior vena cava using a large graft during adult whole liver transplantation is associated with a potential risk of hepatic venous outflow compression/obstruction, which may adversely affect both graft and short-term patient outcomes. Intraoperative placement of materials to restore adequate hepatic venous outflow can overcome this complication.
METHODS
Data of patients who underwent liver transplantation between 2011 and 2016 were retrospectively reviewed. All cases of hepatic venous outflow obstruction due to large graft size managed via intraoperative intervention were analyzed. The literature was searched for studies reporting adult cases of hepatic venous outflow obstruction following whole liver transplantation managed extrahepatically.
RESULTS
Three patients diagnosed with intraoperative hepatic venous outflow obstruction due to large graft size were managed via retro-hepatic placement of breast implants (2 cases) or abdominal pads (1 case). It was successfully carried out in all cases. Four studies including 15 patients were identified in the literature search. Different types of materials such as inflatable materials (Foley catheter, Blakemore balloon), surgical gloves or breast implants, were used.
CONCLUSIONS
Placement of inflatable materials leads to gradual deflation in the postoperative period, which might obviate the need for reoperation. Breast implants could be left in place indefinitely due to their bio-inert nature.

Keyword

Hepatic venous outflow; Breast implants; Abdominal pads; Surgical gloves; Inflatable materials

MeSH Terms

Adult
Breast Implants
Budd-Chiari Syndrome*
Catheters
Gloves, Surgical
Humans
Liver Transplantation*
Liver*
Postoperative Period
Reoperation
Retrospective Studies
Transplants*
Vena Cava, Inferior

Figure

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  Fig. 1 (A) Intraoperative view after placement of a single breast implant (yellow arrow) between the diaphragm and the graft. (B and C) Computed tomography (CT) scans were taken after liver transplantation.

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  Fig. 2 (A) Computed tomography (CT) scan after liver transplantation showing the placement of 2 breast implants (yellow arrow). (B) CT scan after liver transplantation showing the placement of abdominal pads (red arrow).

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