title: Venous outflow obstruction after orthotopic liver transplantation: use of a breast implant to maintain graft position.
abstract: Hepatic venous outflow obstruction (HVOO) is a rare complication after orthotopic liver transplantation (OLT) usually related to technical issues or to malposition or kinking of the hepatic graft. When HVOO is diagnosed during the early post-transplant period, surgical options are technically very demanding and outcomes discouraging. Therefore, angioplasty and stent placement have been indicated to avoid a chronic lesion of the graft. Three cases of HVOO after OLT are reported. HVOO was diagnosed during the early post-transplant period and was due to graft malposition in two patients and kinking of the vena cava anastomosis in one. All patients were successfully treated with a 300-cc gel-filled breast implant surgically placed in the right hepatic fossa with the liver graft resting on it. Massive ascites in all three patients disappeared and renal impairment resolved within two wk post-implant placement. No prosthesis-related complications have been observed after a follow-up ranging from 30 to 58 months. We describe a simple and effective method of maintaining the liver graft in an adequate position to achieve prolonged relief of the outflow obstruction for the whole graft and discuss the advantages of a breast implant over stent placement or the use of different balloon catheters.
authors.affiliation: Hepato-biliary Surgery and Liver Transplantation Unit, Hospital Universitario de Cruces, Bilbao, Spain. mgastaka@saludalia.com
authors.forename: Mikel
authors.initials: M
authors.lastname: Gastaca
authors.forename: Andrés
authors.initials: A
authors.lastname: Valdivieso
authors.forename: Patricia
authors.initials: P
authors.lastname: Ruiz
authors.forename: Javier
authors.initials: J
authors.lastname: Gonzalez
authors.forename: Alberto
authors.initials: A
authors.lastname: Ventoso
authors.forename: Jorge Ortiz
authors.initials: JO
authors.lastname: de Urbina
mesh_terms: D000328:Adult; D018427:Breast Implants; D006502:Budd-Chiari Syndrome / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis