Surgical anterior cavoplasty for managing a case of early acute outflow obstruction after liver transplantation

Autores de IIS La Fe

• Vicente Ibáñez Pradas

  Autor

• Eva María Montalvá Orón

  Autor

• Juan José Vila Carbó

  Autor

• Rafael López Andújar

  Autor

Grupos

• Hepatología experimental y Trasplante hepático

  Investigador Principal

  Laia Tolosa Pardo

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.

Keywords

• liver transplantation; paediatric liver transplantation; partial liver transplant; hepatic vein outflow obstruction