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Venous outflow obstruction after orthotopic liver transplantation: use of a breast implant to maintain graft position
Author(s) -
Gastaca Mikel,
Valdivieso Andrés,
Ruiz Patricia,
Gonzalez Javier,
Ventoso Alberto,
de Urbina Jorge Ortiz
Publication year - 2011
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2011.01423.x
Subject(s) - medicine , surgery , implant , complication , stent , liver transplantation , transplantation , anastomosis , balloon , prosthesis , inferior vena cava , radiology
Gastaca M, Valdivieso A, Ruiz P, Gonzalez J, Ventoso A, Ortiz de Urbina J. Venous outflow obstruction after orthotopic liver transplantation: use of a breast implant to maintain graft position.
Clin Transplant 2011: 25: E320–E326. © 2011 John Wiley & Sons A/S. Abstract: Hepatic venous outflow obstruction (HVOO) is a rare complication after orthotopic liver transplantation (OLT) usually related to technical issues or to malposition or kinking of the hepatic graft. When HVOO is diagnosed during the early post‐transplant period, surgical options are technically very demanding and outcomes discouraging. Therefore, angioplasty and stent placement have been indicated to avoid a chronic lesion of the graft. Three cases of HVOO after OLT are reported. HVOO was diagnosed during the early post‐transplant period and was due to graft malposition in two patients and kinking of the vena cava anastomosis in one. All patients were successfully treated with a 300‐cc gel‐filled breast implant surgically placed in the right hepatic fossa with the liver graft resting on it. Massive ascites in all three patients disappeared and renal impairment resolved within two wk post‐implant placement. No prosthesis‐related complications have been observed after a follow‐up ranging from 30 to 58 months. We describe a simple and effective method of maintaining the liver graft in an adequate position to achieve prolonged relief of the outflow obstruction for the whole graft and discuss the advantages of a breast implant over stent placement or the use of different balloon catheters.