title: Cavo-caval intervention stent insertion after deceased-donor liver transplantation using side-to-side piggyback technique: report of a case.
abstract: Liver transplantation with preservation of the recipient vena cava (piggyback technique) has been performed as an alternative to the conventional method. Outflow disturbance or obstruction of the vena cava in the early period after liver transplantation is associated with high morbidity and mortality. We used side-to-side cavo-caval anastomosis (modified piggyback technique) in a deceased-donor liver transplantation (DDLT) for venous outflow reconstruction. On postoperative day 9, the patient developed abdominal discomfort, and abnormal liver function showing serum total bilirubin of 6.2 mg/dl and serum AST/ALT of 297/597 IU/L. Doppler ultrasound showed mono-phasic wave forms of the hepatic vein. Computed tomography showed focal narrowing of 9.5 mm×12 mm in diameter at the cavo-caval anastomosis site. Liver biopsy was showed that there was no evidence of acute allograft rejection. Direct venogram showed stenosis of the cavo-caval anastomosis with a pressure gradient of 12 mmHg. An interventional stent was inserted in the stenotic site of the inferior vena cava, and the pressure gradient decreased to 2 mmHg. He was discharged from hospital on postoperative day 23 without any other complications. Herein we report a case of deceased-donor liver transplantation using the modified piggyback technique, who received an inferior vena cava stent due to stricture of the reconstructed orifice of the vena cava.
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: In-Gyu
authors.initials: IG
authors.lastname: Kim
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Byung Seup
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Jang Yong
authors.initials: JY
authors.lastname: Jeon
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kwon
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Joo Seop
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Doo Jin
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Jung
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Seong Eun
authors.initials: SE
authors.lastname: Chon
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Han Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Eui Yong
authors.initials: EY
authors.lastname: Jeon
authors.affiliation: Department of Radiology, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Min-Jeong
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Kwanseop
authors.initials: K
authors.lastname: Lee
keywords: Anastomotic stenosis; Liver transplantation; Outflow obstruction; Stent