title: Intrahepatic hepatic vein stenosis after living-related liver transplantation treated by insertion of an expandable metallic stent.
abstract: Although the incidence of stenosis and obstruction of the hepatic venous anastomosis after right hepatic living-related liver transplantation (LRLT) has been found to be higher than after orthotopic liver transplantation (OLT), to the best of our knowledge, intrahepatic stenosis of the venous trunk in the early period after right hepatic LRLT has never been reported in the literature. A 53-year-old man who underwent right hepatic LRLT, postoperatively, developed liver dysfunction and an increasing amount of ascites, and a Doppler sonogram showed a flat waveform and low-flow velocity in the hepatic vein. Based on these findings an outflow block was suspected, and a hepatic venogram and manometry revealed intrahepatic stenosis of a tortuous hepatic venous trunk and a pressure gradient of 14 mmHg at the site of the stenosis. We inserted an expandable metallic stent (EMS) at the site of intrahepatic venous stenosis, and its insertion was followed by a decrease in pressure gradient. Liver function recovered, and the volume of ascitic fluid decreased after placement of the EMS. The results of an analysis of the venogram and CT volumetric data suggested that the pathogenesis of the stenosis was twisting of the venous trunk during hypertrophy of the liver parenchyma.
authors.affiliation: First Department of Surgery, Mie University School of Medicine, Tsu City, Mie Prefecture, Japan. yamagw-k@clin.medic.mie-u.ac.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamagiwa
authors.forename: Hajime
authors.initials: H
authors.lastname: Yokoi
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
authors.forename: Masami
authors.initials: M
authors.lastname: Tabata
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamakado
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Kan
authors.initials: K
authors.lastname: Takeda
mesh_terms: D001202:Ascitic Fluid; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents; D018615:Ultrasonography, Doppler, Color; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging