[The cause and management of postoperative venous outflow obstruction after orthotopic liver transplantation].
OBJECTIVE
To investigate the causes and treatment of postoperative venous outflow obstruction after orthotopic liver transplantation (OLT).


METHODS
Clinical data of 776 patients after OLT were analyzed retrospectively between January 2000 and December 2006. The accumulated experiences in diagnosis and treatment of postoperative outflow obstruction after OLT were reviewed.


RESULTS
Venous outflow obstruction occurred in 10 patients (1.29%) after OLT, among those 6 had supra-hepatic inferior vena cava (IVC) stenosis, 2 had IVC stenosis of the post-hepatic segment, and 2 had outflow obstruction of hepatic vein. The diagnosis was confirmed by inferior vena cavography in all the patients. Of the 10 patients, 8 received percutaneous transluminal angioplasty (PTA) or metallic stent replacement, and 2 underwent liver retransplantation (re-LT) when interventional therapy failed. Three patients died from outflow obstruction, so the outflow obstruction related mortality was 30% in the patients.


CONCLUSIONS
Complications of outflow obstruction after OLT were associated with surgical technique like vascular anastomosis, various types of cavo-caval anastomosis and graft size mismatch between donor and recipient. Making an early diagnosis and giving timely treatment including interventional therapy or re-LT is the key to improve the prognosis of outflow obstruction.
Ma
Yi
Y
Department of Transplantation Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China. anhuimayi2002@163.com
He
Xiao-shun
XS
Zhu
Xiao-feng
XF
Wang
Guo-dong
GD
Wang
Dong-ping
DP
Ju
Wei-qiang
WQ
Wu
Lin-wei
LW
Hu
An-bin
AB
Tai
Qiang
Q
D000293:Adolescent; D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000209:etiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies