Hepatic venous outflow obstruction in paediatric liver transplantation.
BACKGROUND
Vascular complications after orthotopic split liver transplantation in children result in significant post-operative complications.


METHODS
A review of children undergoing liver transplantation from 2004 to 2006 was undertaken. The data was obtained based on a proforma-based analysis.


RESULTS
Seven of 106 transplants were identified to have hepatic venous outflow obstruction (HVOO) of whom five were males and two were females. Median age at transplant was 8 years (range 3 years 4 months-15 years). The median donor-to-recipient weight ratio was 2.78 (range 0.97-6.15). ANASTOMOTIC TECHNIQUE: Hepatic vein-IVC in four, Hepatic vein-hepatic vein (HV-IVC) confluence in two and cavo hepatic in one. Ascites was the commonest post op manifestation of HVOO. Although Doppler USG was useful in identifying the venous outflow obstruction, venography confirmed the exact site of obstruction aiding in therapeutic dilatation. Three of seven cases had early onset (<1 month) while 4/7 had late onset (>1 month). 5/7 underwent venography and dilatation, of whom three are well and one is awaiting a repeat venography and dilatation. 2/7 died without intervention and 1/7 died in the waiting list for retransplantation.


CONCLUSIONS
The diagnosis of HVOO requires a high index of suspicion, prompting early venography to manage HVOO successfully. Technical steps to avoid HVOO are to keep the hepatic vein-caval anastomosis short and wide with triangulation and to avoid graft rotation at the hepato caval junction.
Liver Unit, Birmingham Children's Hospital, Birmingham, UK. sasisang@rediffmail.com
G
G
Krishna Kumar
Khalid
K
Sharif
David
D
Mayer
Darius
D
Mirza
Katharine
K
Foster
Deirdre
D
Kelly
A J W
AJ
Millar
D000293:Adolescent; D001201:Ascites / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D010690:Phlebography / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D015607:Stents; D016019:Survival Analysis