Late Hepatic Venous Outflow Obstruction Following Inferior Vena Cava Stenting in Patient with Deceased Donor Liver Transplantation Using Modified Piggyback Technique

Jae Min Chun; Heontak Ha; Young Yeon Choi; Hyung Jun Kwon; Sang Geol Kim; Yoon Jin Hwang; Hunkyu Ryeom; Young Seok Han

doi:10.4285/jkstn.2016.30.2.89

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Chun, Ha, Choi, Kwon, Kim, Hwang, Ryeom, and Han: Late Hepatic Venous Outflow Obstruction Following Inferior Vena Cava Stenting in Patient with Deceased Donor Liver Transplantation Using Modified Piggyback Technique

Case Report

J Korean Soc Transplant 2016;30(2):89-93.

Published online: 19 January 2016

DOI: https://doi.org/10.4285/jkstn.2016.30.2.89

Late Hepatic Venous Outflow Obstruction Following Inferior Vena Cava Stenting in Patient with Deceased Donor Liver Transplantation Using Modified Piggyback Technique

Jae Min Chun, M.D.¹, Heontak Ha, M.D.¹, Young Yeon Choi, M.D.¹, Hyung Jun Kwon, M.D.¹, Sang Geol Kim, M.D.¹, Yoon Jin Hwang, M.D.¹, Hunkyu Ryeom, M.D.², Young Seok Han, M.D.^1,

¹Departments of Surgery, Kyungpook National University School of Medicine, Daegu, Korea

²Departments of Surgery and Radiology, Kyungpook National University School of Medicine, Daegu, Korea

Corresponding author: Young Seok Han Department of Surgery, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: 82-53-420-5605, Fax: 82-53-421-0510 E-mail: gshys@knu.ac.kr

Received 22 March 2016 Revised 4 April 2016 Accepted 10 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Following liver transplantation, a few reports have documented hepatic venous outflow obstruction (HVOO) after inferior vena cava (IVC) stenting for the treatment of IVC stenosis. However, HVOO occurred early after IVC stenting and was mostly associated with living donor liver transplantation. Here, we report a case of HVOO that occurred 31 months after IVC stenting in a man who received deceased donor liver transplantation (DDLT) using a modified piggyback (PB) technique. The cause of HVOO was unclear, but one possible explanation is that the balloon-expandable IVC stent might have compressed the IVC chamber on the donor liver side, which would have changed the outflow hemodynamics, resulting in intimal hyperplasia. Therefore, simultaneous hepatic venous stenting with IVC stent placement could help prevent HVOO in patients receiving DDLT with the modified PB technique.

Keywords: Modified piggyback technique, Inferior vena cava stent, Heptic venous outflow obstruction

REFERENCES

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Fig. 1.

Abdominal computed tomography scan of the patient performed prior to receiving deceased donor liver transplantation. (A) The cranial end of the transjugular intrahepatic portosystemic shunt (TIPS) stent was located just below the right atrium, across the suprahepatic vena cava (arrow). (B) The caudal end of TIPS stent was placed at the junction of the inferior mesenteric and splenic veins (arrow).

Fig. 2.

This abdominal computed tomography scan of the patient performed 6 weeks after deceased donor liver transplantation shows stenosis of the suprahepatic vena cava (arrows). (A) Axial view. (B) Coronal view.

Fig. 3.

This contrast-enhanced abdominal computed tomography (CT) scan shows a collapsed inferior vena cava (IVC) chamber on the donor side, a large amount of ascites fluid and liver graft congestion. (A) In comparison with the previous CT scan, the donor side IVC chamber had collapsed from extrinsic compression of the Palmaz stent (arrow). (B) A mottled pattern of contrast enhancement was observed in the portal venous phase.

Fig. 4.

The venogram demonstrated (A) hepatic venous outflow obstruction with a pressure gradient of 20 mmHg (arrow) and (B) edge stenosis at the inferior vena cava under the stent (arrow).

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