Outflow block secondary to stenosis of the inferior vena cava following living-donor liver transplantation?
Although it is well known that outflow block is caused by stenosis or occlusion of hepatic vein anastomoses following living donor liver transplantation (LDLT), there have been few reports on inferior vena cava (IVC) stenosis following LDLT. In this paper, we report two cases of IVC stenosis and hepatic vein outflow block following right hepatic LDLT in the absence of stenosis of any of the anastomoses. Both patients presented with liver dysfunction, an ascitic fluid volume of approximately 2000 mL, and congestion in their biopsy specimens, and venocavography demonstrated IVC stenosis with gradients of more than 10 mmHg in patients with a dominant inferior right hepatic vein (IRHV) anastomosis. After a Gianturco expandable metallic stent successfully implanted in the IVC, the patient's liver function recovered and the volume of ascitic fluid decreased. The pathogenesis of hepatic vein outflow block secondary to IVC stenosis following LDLT may involve the anastomosis with the IRHV, which is the dominant draining vein of the graft and larger than the RHV, caudal to the IVC stenosis and a significant IVC pressure gradient that results in increased IRHV pressure. In conclusion, it is important to include hepatic vein outflow block in the differential diagnosis when patients who have undergone right hepatic LDLT in which anastomosis of the large IRHV has been performed develop manifestations of liver dysfunction.
Mizuno
Shugo
S
First Department of Surgery, Mie University School of Medicine, Mie, Japan. mizuzmido@mtj.biglobe.ne.jp
Yokoi
Hajime
H
Yamagiwa
Kentaro
K
Tabata
Masami
M
Isaji
Shuji
S
Yamakado
Koichiro
K
Takeda
Kan
K
Uemoto
Shinji
S
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001201:Ascites / Q000209:etiology; D006502:Budd-Chiari Syndrome / Q000209:etiology*; D003251:Constriction, Pathologic / Q000150:complications; D005260:Female; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008099:Liver / Q000503:physiopathology; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011183:Postoperative Complications; D015607:Stents; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D014690:Venous Pressure / Q000502:physiology