title: Hepatic venous outflow obstruction after right lateral sector living-donor liver transplantation, treated by insertion of an expandable metallic stent.
abstract: Hepatic venous outflow obstruction is a relatively uncommon but important and devastating complication occurring after liver transplantation. Recently, right lateral sector liver grafts have sometimes been used in living-donor liver transplantation (LDLT), but, to our knowledge, early hepatic venous outflow obstruction has never been reported in right lateral sector LDLT. A 58-year-old woman was diagnosed with liver cirrhosis and hepatocellular carcinoma and underwent right lateral sector LDLT. Postoperatively, she developed liver dysfunction. Doppler ultrasound examination revealed flat waveforms and low-flow velocity in the right hepatic vein (RHV). A computed tomography (CT) scan revealed a ventrally distorted RHV due to hypertrophy of the liver graft. Hepatic venous obstruction was suspected and a hepatic venogram was performed. The venogram revealed stenosis of the RHV due to the distortion of the vein. We performed percutaneous transfemoral balloon dilatation, but this was not effective. We then inserted an expandable metallic stent (EMS) into the RHV. After the EMS placement, the condition of the patient improved. Venogram and CT data suggested that the obstruction of the RHV developed because of distortion of the RHV to the ventral side during liver regeneration.
authors.affiliation: Second Department of Surgery, Faculty of Medicine, Hiroshima University, 1-2-3 Kasumi, Hiroshima 734-8551, Japan.
authors.forename: Yoshisato
authors.initials: Y
authors.lastname: Tanimoto
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Itamoto
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Toyota
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kohashi
authors.forename: Hironobu
authors.initials: H
authors.lastname: Amano
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishiyama
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oshita
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Asahara
mesh_terms: D006502:Budd-Chiari Syndrome / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008875:Middle Aged; D015607:Stents