Treatment of hepatic venous outflow stenosis after living donor liver transplantation by insertion of an expandable metallic stent.
BACKGROUND
Hepatic venous outflow stenosis is an uncommon but serious complication after right lobe living donor liver transplantation (LDLT). Failure to recognize and treat this complication early can result in graft failure and even death. The early diagnosis and management of hepatic venous outflow stenosis has become an important issue.


METHODS
We report a case with this complication treated by endovascular stent placement in the early period after right lobe LDLT and review related reports to explore the possible mechanism.


RESULTS
A 44-year-old man with end-stage hepatitis B liver cirrhosis underwent right lobe LDLT. On postoperative day 13, his liver function deteriorated and he developed refractory ascites for maximal diuretic therapy. Hepatic venography showed a stenosis with an element of torsion of the venous drainage proximal to the anastomosis of the right hepatic venous orifice and inferior vena cava. The stenosis was successfully treated by insertion of an expandable metallic stent.


CONCLUSIONS
The result demonstrates that stent placement for stenosis is safe and effective. We suspect that rapid hypertrophy of an asymmetric right lobe graft may result in hepatic venous outflow stenosis caused by twisting or external compression of the hepatic veins.
Liu
Xiao-Long
XL
Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China.
Li
Fu-Qiang
FQ
Li
Xiao
X
Li
Bo
B
Yan
Lu-Nan
LN
Wei
Yong-Gang
YG
D000328:Adult; D006502:Budd-Chiari Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation*; D003251:Constriction, Pathologic; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006509:Hepatitis B / Q000150:complications / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008670:Metals; D010690:Phlebography; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D008670:Metals