title: Hepatic venous outflow obstruction in piggyback liver transplantation: single centre experience.
abstract: BACKGROUND
  Hepatic venous outflow obstruction (HVOO) is a rare but serious complication in liver transplantation (LT).
  
  
  METHODS
  We conducted a retrospective analysis of HVOO with venography and gradient measurement in consecutive LT from a single centre.
  
  
  RESULTS
  Five hundred and six LTs were performed in 486 patients with a median age of 49 years (range 3 months to 71 years). Nineteen (3.8%) cases of HVOO were identified. Diagnosis was confirmed at a median of 26 days post-LT (1-2312). The incidence fell from 5.5% in the first 253 LT, to 2.0% in the second 253 (P = 0.03). Seventeen were due to narrowing at the anastomosis and two cases were due to thrombosis. In adult patients, reconstruction of the supra-hepatic donor inferior vena cava (IVC) onto two veins versus modified 2-3 hepatic veins did not alter the likelihood of HVOO. 17/19 cases were managed successfully by stenting or venoplasty. Two paediatric patients with early onset HVOO had attempted surgical thrombectomy, one was successful and the other required retransplantation.
  
  
  CONCLUSIONS
  The incidence of HVOO appears to fall with increasing experience and does not appear to be related to the number of veins the donor IVC is anastomosed to in adult recipients.
authors.affiliation: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Joel
authors.initials: J
authors.lastname: Arudchelvam
authors.affiliation: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.|Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Adam
authors.initials: A
authors.lastname: Bartlett
authors.affiliation: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.|Department of Surgery, University of Otago, Dunedin, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: McCall
authors.affiliation: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Johnston
authors.affiliation: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Edward
authors.initials: E
authors.lastname: Gane
authors.affiliation: New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Stephen
authors.initials: S
authors.lastname: Munn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000209:etiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult
keywords: hepatic veno-occlusive disease; liver transplantation; post-operative complications; surgical technique