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Lim C, Osseis M, Tudisco A, Lahat E, Sotirov D, Salloum C, Azoulay D. Hepatic venous outflow obstruction after whole liver transplantation of large-for-size graft: versatile intra-operative management. Ann Hepatobiliary Pancreat Surg 2018; 22:321-325. [PMID: 30588522 PMCID: PMC6295374 DOI: 10.14701/ahbps.2018.22.4.321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/03/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Michael Osseis
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Antonella Tudisco
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Eylon Lahat
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Dobromir Sotirov
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Chady Salloum
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Daniel Azoulay
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.,Université Paris-Est UPEC, Créteil, France.,INSERM, U955, Créteil, France
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Pitchaimuthu M, Roll GR, Zia Z, Olliff S, Mehrzad H, Hodson J, Gunson BK, Perera MTPR, Isaac JR, Muiesan P, Mirza DF, Mergental H. Long-term follow-up after endovascular treatment of hepatic venous outflow obstruction following liver transplantation. Transpl Int 2016; 29:1106-16. [DOI: 10.1111/tri.12817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/07/2016] [Accepted: 06/28/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Liver Unit Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Garrett R. Roll
- Liver Unit Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
- Division of Transplant Surgery; University of California; San Francisco CA USA
| | - Zergham Zia
- Department of Radiology; Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Simon Olliff
- Department of Radiology; Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Homoyoon Mehrzad
- Department of Radiology; Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - James Hodson
- National Institute for Health Research Birmingham; Liver Biomedical Research Unit and Centre for Liver Research; Institute of Immunology and Immunotherapy; College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - Bridget K. Gunson
- National Institute for Health Research Birmingham; Liver Biomedical Research Unit and Centre for Liver Research; Institute of Immunology and Immunotherapy; College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - M. Thamara P. R. Perera
- Liver Unit Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - John R. Isaac
- Liver Unit Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Paolo Muiesan
- Liver Unit Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| | - Darius F. Mirza
- Liver Unit Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
- National Institute for Health Research Birmingham; Liver Biomedical Research Unit and Centre for Liver Research; Institute of Immunology and Immunotherapy; College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - Hynek Mergental
- Liver Unit Queen Elizabeth Hospital; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
- National Institute for Health Research Birmingham; Liver Biomedical Research Unit and Centre for Liver Research; Institute of Immunology and Immunotherapy; College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
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Kitajima T, Kaido T, Iida T, Yagi S, Fujimoto Y, Ogawa K, Mori A, Okajima H, Imamine R, Shibata T, Uemoto S. Left lobe graft poses a potential risk of hepatic venous outflow obstruction in adult living donor liver transplantation. Liver Transpl 2016; 22:785-95. [PMID: 26785423 DOI: 10.1002/lt.24399] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/03/2016] [Accepted: 12/31/2015] [Indexed: 02/07/2023]
Abstract
Hepatic venous outflow obstruction (HVOO) is a critical complication after living donor liver transplantation (LDLT). This study aimed to evaluate the incidence of HVOO and the risk factors for HVOO in adults. From 2005 to 2015, 430 adult LDLT patients (right lobe [RL] graft, 270 patients; left lobe [LL] graft, 160 patients) were enrolled and divided into no HVOO (n = 413) and HVOO (n = 17) groups. Patient demographics and surgical data were compared, and risk factors for HVOO were analyzed. Furthermore, the longterm outcomes of percutaneous interventions as treatment for HVOO were assessed. HVOO occurred in 17 (4.0%) patients. The incidence of HVOO in patients receiving a LL graft was significantly higher than in those receiving a RL graft (8.1% versus 1.5%; P = 0.001). The body weight and caliber of hepatic vein anastomosis in the HVOO group were significantly lower compared with the no HVOO group (P = 0.02 and P = 0.008, respectively). Multivariate analysis revealed that only LL graft was an independent risk factor for HVOO (OR, 4.782; 95% CI, 1.387-16.488; P = 0.01). Among 17 patients with HVOO, 7 patients were treated with single balloon angioplasty, and 9 patients who developed recurrence were treated with repeated interventions. Overall, 6 patients underwent stent placement: 1 at the initial procedure, 3 at the second procedure for early recurrence, and 2 following repeated balloon angioplasty (≥3 interventions). These 6 patients experienced no recurrence. Overall graft survival was not significantly different between the HVOO and no HVOO groups (P = 0.99). In conclusion, the use of a LL graft was associated with HVOO, and percutaneous interventions were effective for treating adult HVOO after LDLT. Liver Transplantation 22 785-795 2016 AASLD.
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Affiliation(s)
- Toshihiro Kitajima
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
| | - Taku Iida
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
| | - Shintaro Yagi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
| | - Yasuhiro Fujimoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
| | - Kohei Ogawa
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
| | - Akira Mori
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
| | - Hideaki Okajima
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
| | - Rinpei Imamine
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Shibata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto, Japan
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Wahab MA, Shehta A, Hamed H, Elshobary M, Salah T, Sultan AM, Fathy O, Elghawalby A, Yassen A, Shiha U. Hepatic venous outflow obstruction after living donor liver transplantation managed with ectopic placement of a foley catheter: A case report. Int J Surg Case Rep 2015; 10:65-8. [PMID: 25805611 PMCID: PMC4429842 DOI: 10.1016/j.ijscr.2015.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/08/2015] [Accepted: 03/09/2015] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The early hepatic venous outflow obstruction (HVOO) is a rare but serious complication after liver transplantation, which may result in graft loss. We report a case of early HVOO after living donor liver transplantation, which was managed by ectopic placement of foley catheter. PRESENTATION A 51 years old male patient with end stage liver disease received a right hemi-liver graft. On the first postoperative day the patient developed impairment of the liver functions. Doppler ultrasound (US) showed absence of blood flow in the right hepatic vein without thrombosis. The decision was to re-explore the patient, which showed torsion of the graft upward and to the right side causing HVOO. This was managed by ectopic placement of a foley catheter between the graft and the diaphragm and the chest wall. Gradual deflation of the catheter was gradually done guided by Doppler US and the patient was discharged without complications. DISCUSSION Mechanical HVOO results from kinking or twisting of the venous anastomosis due to anatomical mismatch between the graft and the recipient abdomen. It should be managed surgically by repositioning of the graft or redo of venous anastomosis. Several ideas had been suggested for repositioning and fixation of the graft by the use of Sengstaken-Blakemore tubes, tissue expanders, and surgical glove expander. CONCLUSION We report the use of foley catheter to temporary fix the graft and correct the HVOO. It is a simple and safe way, and could be easily monitored and removed under Doppler US without any complications.
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Affiliation(s)
- Mohamed Abdel Wahab
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Shehta
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
| | - Hosam Hamed
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Mohamed Elshobary
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Tarek Salah
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Mohamed Sultan
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Omar Fathy
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Elghawalby
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Amr Yassen
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Usama Shiha
- Radiology Department, Gatroenterology Surgical Center, Mansoura University, Egypt
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Latchana N, Dowell JD, Al Taani J, Michaels A, Elkhammas E, Black SM. Ultrasound-accelerated, catheter-directed thrombolysis for inferior vena cava thrombosis after an orthotopic liver transplant. EXP CLIN TRANSPLANT 2014; 13:96-9. [PMID: 24918871 DOI: 10.6002/ect.2013.0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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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Affiliation(s)
- Nicholas Latchana
- From the Department of Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Aguirre-Avalos G, Covarrubias-Velasco MA, Rojas-Sánchez AG. Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:354-8. [PMID: 24046802 PMCID: PMC3775614 DOI: 10.12659/ajcr.889261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 05/16/2013] [Indexed: 12/12/2022]
Abstract
Patient: Female, 54 Final Diagnosis: Suprahepatic inferior vena cava anastomosis stricture Symptoms: Ascites • fatigue • lower limb edema • hepatomegaly Medication: — Clinical Procedure: — Specialty: Transplantology • Critical Care Medicine
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Affiliation(s)
- Guadalupe Aguirre-Avalos
- Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara Jalisco, México ; Investigación en Microbiología Médica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara Jalisco, México
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Mori A, Kaido T, Ogura Y, Ogawa K, Hata K, Yagi S, Yoshizawa A, Isoda H, Shibata T, Uemoto S. Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation. Liver Transpl 2012; 18:602-7. [PMID: 22253117 DOI: 10.1002/lt.23387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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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Affiliation(s)
- Akira Mori
- Department of Surgery (Division of Hepato-Biliary-Pancreatic Surgery and Transplantation)Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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