Isolated Right Hepatic Vein (RHV) Obstruction after Piggyback Liver Transplantation, an Infrahepatic Terminolateral Cavo-Cavostomy as a Rescue Technique to Save the Graft
Transplant Unit, National Medical Center "20 de Noviembre", Mexico City, Mexico.
Meeting: 2018 American Transplant Congress
Abstract number: A258
Keywords: Liver grafts, Liver transplantation, Outcome, Post-operative complications
Session Information
Date: Saturday, June 2, 2018
Session Name: Poster Session A: Liver Retransplantation and Other Complications
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Background: The “piggyback” technique for liver transplantation (LT) has gained acceptance around the world. However, outflow problems are more common than the classic technique.
Material and Methods: We describe a case of a 44-year-old female with primary biliary cirrhosis who underwent (LT) with piggyback technique. During the construction of the vena cava anastomosis the liver clamp slid from the original position narrowing the right corner of the RHV. Due to the width of the anastomosis we did not suspect the RHV to have an outflow problem at that moment. We continued performing the LT, reperfusion was uneventful so we continued with the hepatic artery. At this point the liver started to become congested so a careful examination was performed which demonstrated a narrowing and kinking of the RHV, resulting in outflow being obstructed.
To resolve the problem, we faced two potential options. The first solution was to re-perform the cava anastomosis but this seemed very dangerous for the patient because of the need to allow a long period of graft ischemia. Our second option was to perform an end-to-side anastomosis between the infrahepatic stump of the donor´s vena cava (VC) and the recipient´s (VC). After performing the second option we removed the clamps and the liver returned to a soft texture.
The transplantation was completed and the postoperative course was uneventful with the Doppler ultrasound showing a good outflow triphasic wave. The patient is still alive three months after the LT.
Conclusion: The lateral cavo-cavostomy of the inferior hepatic vein of the donor is a feasible and safe procedure to save a liver graft facing intraoperative outflow problems.
CITATION INFORMATION: Pineda-Solis K., Florez-Zorrilla C., Sanchez-Cedillo A., Ladrón de Guevara-Cetrina L. Isolated Right Hepatic Vein (RHV) Obstruction after Piggyback Liver Transplantation, an Infrahepatic Terminolateral Cavo-Cavostomy as a Rescue Technique to Save the Graft Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Pineda-Solis K, Florez-Zorrilla C, Sanchez-Cedillo A, Guevara-Cetrina LLadrónde. Isolated Right Hepatic Vein (RHV) Obstruction after Piggyback Liver Transplantation, an Infrahepatic Terminolateral Cavo-Cavostomy as a Rescue Technique to Save the Graft [abstract]. https://atcmeetingabstracts.com/abstract/isolated-right-hepatic-vein-rhv-obstruction-after-piggyback-liver-transplantation-an-infrahepatic-terminolateral-cavo-cavostomy-as-a-rescue-technique-to-save-the-graft/. Accessed October 25, 2020.« Back to 2018 American Transplant Congress