Abstract
Hepatic venous drainage in liver transplantation may be reduced to the level of caval anastomosis producing an obstruction degree and leading to serious vascular complication such as the acute Budd-Chiari syndrome, which may result in organ loss. Outflow obstruction may be caused by lack of technique in caval anastomosis or by allograft malposition as a consequence of anatomical graft and recipient conditions. Fixation of the round ligament, placement of bowel loops and use of tissue expanders have been described to stabilize graft position during liver transplantation with related procedure complications. We report our experience of a simple homemade device using a surgical glove expander that allowed us to successfully avoid outflow obstruction in all of nine treated patients. No device related complications occurred. In malposed liver allografts, we strongly suggest the use of this simple and safe device to avoid hepatic venous outflow obstruction on condition that the device is early removed within 48 hours.
Highlights
Outflow obstruction in liver transplantation causes graft dysfunction and eventual graft loss
Hepatic venous drainage in liver transplantation may be reduced to the level of caval anastomosis producing an obstruction degree and leading to serious vascular complication such as the acute Budd-Chiari syndrome, which may result in organ loss
We strongly suggest the use of this simple and safe device to avoid hepatic venous outflow obstruction on condition that the device is early removed within 48 hours
Summary
Outflow obstruction in liver transplantation causes graft dysfunction and eventual graft loss. Venous drainage after liver transplantation (LT) may be hindered by the level of caval anastomosis, producing an obstruction degree leading to the most serious acute Budd-Chiari syndrome (B-C) which may lead to organ loss. It may be caused by lack of technique in caval anastomosis construction resulting in a stenosis of anastomosis, and by graft and/or recipient anatomical conditions resulting in an allograft malposition. The caval anastomosis proves to be a sort of hinge which does not allow antero-posterior mobility (Figure 2)
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