Abstract
Hepatic venous outflow obstruction following liver transplantation is rare but disastrous. Here we described a 14-year-old boy who underwent a split right lobe liver transplantation with modified (side-to-side) piggyback technique which resulted in hepatic venous outflow obstruction. When the liver graft was lifted up, the outflow drainage returned to normal but when it was placed back into the abdomen, the outflow obstruction recurred. Because reanastomosis would have resulted in hepatic reischemia, alternatively, a second infrahepatic cavocavostomy was planned without requiring hepatic reischemia. During this procedure, the first assistant hung the liver up to provide sufficient outflow and the portal inflow of the graft continued as well. We only clamped the recipient's infrahepatic vena cava and the caudal cuff of the graft cava. After the second end-to-side cavocaval anastomosis, the graft was placed in its orthotopic position and there was no outflow problem anymore. The patient tolerated the procedure well and there were no problems after three months of follow-up. A second cavocavostomy can provide an extra bypass for some hepatic venous outflow problems after piggyback anastomosis by avoiding hepatic reischemia.
Highlights
There are several vascular complications of liver transplantation diagnosed intraoperatively
It can be corrected with a reanastomosis; this is potentially harmful due to the necessity of reclamping of hepatic inflow that prolongs the warm ischemia time
The problem was solved by an infrahepatic second cavocaval anastomosis without occlusion of the hepatic inflow or outflow
Summary
There are several vascular complications of liver transplantation diagnosed intraoperatively. Venous outflow obstruction during liver transplantation is a serious problem which may lead to loss of the graft. It can be corrected with a reanastomosis; this is potentially harmful due to the necessity of reclamping of hepatic inflow that prolongs the warm ischemia time. A case of hepatic outflow obstruction during a split right lobe liver transplantation with a modified piggyback cavocaval anastomosis technique was described. The problem was solved by an infrahepatic second cavocaval anastomosis without occlusion of the hepatic inflow or outflow
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