title: Surgical anterior cavoplasty for managing a case of early acute outflow obstruction after liver transplantation.
abstract: HVOO following liver transplantation is rarely treated surgically because it tends to debut subacutely. However, acute HVOO is a surgical emergency that compromises the viability of the graft. We report a case of HVOO diagnosed intra-operatively during surgical revision for a suspected arterial thrombosis in a 10-month-old male recipient of a second graft (segments II-III) for familial intrahepatic cholestasis. HVOO was related to a stenosis at the first transplant hepato-caval anastomosis, left in place to obtain longer venous cuffs for retransplantation. An anterior cavoplasty was necessary to resolve the issue. The new anastomosis was created under total vascular exclusion after gaining control of the supradiaphragmatic vena cava, because the inferior vena cava was unsuitable for further surgery. This approach (normally used as a means to avoid sternotomy in patients with hepatic or renal tumours associated with venous thrombosis) allows adequate vascular control and, in selected cases, offers a surgical alternative for treating HVOO.
authors.affiliation: Liver Transplant Unit, La Fe University and Politecnic Hospital, Valencia, Spain.
authors.forename: Vicente
authors.identifier: http://orcid.org/0000-0002-4018-9050
authors.initials: V
authors.lastname: Ibáñez
authors.affiliation: Liver Transplant Unit, La Fe University and Politecnic Hospital, Valencia, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Montalvá
authors.affiliation: Liver Transplant Unit, La Fe University and Politecnic Hospital, Valencia, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Vila
authors.affiliation: Liver Transplant Unit, La Fe University and Politecnic Hospital, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: López-Andújar
mesh_terms: D002780:Cholestasis, Intrahepatic / Q000601:surgery*; D003251:Constriction, Pathologic; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000601:surgery; D011184:Postoperative Period; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014682:Vena Cava, Inferior / Q000601:surgery*
keywords: hepatic vein outflow obstruction; liver transplantation; paediatric liver transplantation; partial liver transplant