The cause and management of postoperative venous outflow obstruction after orthotopic liver transplantation

OBJECTIVE: To investigate the causes and treatment of postoperative venous outflow obstruction after orthotopic liver transplantation (OLT). METHODS: Clinical data of 776 patients after OLT were analyzed retrospectively between January 2000 and December 2006. The accumulated experiences in diagnosis and treatment of postoperative outflow obstruction after OLT were reviewed. RESULTS: Venous outflow obstruction occurred in 10 patients (1.29%) after OLT, among those 6 had supra-hepatic inferior vena cava (IVC) stenosis, 2 had IVC stenosis of the post-hepatic segment, and 2 had outflow obstruction of hepatic vein. The diagnosis was confirmed by inferior vena cavography in all the patients. Of the 10 patients, 8 received percutaneous transluminal angioplasty (PTA) or metallic stent replacement, and 2 underwent liver retransplantation (re-LT) when interventional therapy failed. Three patients died from outflow obstruction, so the outflow obstruction related mortality was 30% in the patients. CONCLUSIONS: Complications of outflow obstruction after OLT were associated with surgical technique like vascular anastomosis, various types of cavo-caval anastomosis and graft size mismatch between donor and recipient. Making an early diagnosis and giving timely treatment including interventional therapy or re-LT is the key to improve the prognosis of outflow obstruction.