title: Outflow block secondary to stenosis of the inferior vena cava following living-donor liver transplantation?
abstract: 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.
authors.affiliation: First Department of Surgery, Mie University School of Medicine, Mie, Japan. mizuzmido@mtj.biglobe.ne.jp
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Hajime
authors.initials: H
authors.lastname: Yokoi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamagiwa
authors.forename: Masami
authors.initials: M
authors.lastname: Tabata
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamakado
authors.forename: Kan
authors.initials: K
authors.lastname: Takeda
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: 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