Caval reconstruction techniques in orthotopic liver transplantation

Beal, Eliza W.; Bennett, Shaylyn; Whitson, Bryan A.; Elkhammas, Elmahdi A; Henry, Mitchell L.; Black, Sylvester M.

doi:10.5412/wjsp.v5.i1.41

Cited by 5 publications

(6 citation statements)

References 57 publications

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“…This may reflect the recent period of the study where surgical outcomes have improved significantly but possibly also our policy to tailor the technique according to the intraoperative findings of each patient. In the literature, both CR and CP offer good outcomes, and it has been suggested that surgeons should prefer the technique that they know best [22].…”

Section: Discussionmentioning

confidence: 99%

Initial piggyback technique facilitates late liver retransplantation – a retrospective monocentric study

et al. 2021

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Optimal management of inferior vena cava (IVC) is crucial to ensure safety in late liver retransplantation (ReLT). The aim of this study was to evaluate different surgical strategies with regard to IVC in late ReLT. All consecutive late ReLT (≥90 days from the previous transplant) from 2013 to 2018 in a single center was reviewed (n = 66). Of them, 46 (69.7%) were performed without venovenous bypass (VVB) including 29 with caval preservation (CP) and 17 with caval replacement (CR). The remaining 20 cases (30.3%) required the use of VVB. Among ReLT without VVB, CP was associated with a lower number of packed red blood cells (median 4 vs. 7; P = 0.016) and a lower incidence of post-transplant acute kidney injury (6.9% vs. 47.1%; P = 0.003). The feasibility of CP was 95% (14/15) in patients with previous 3-vein piggyback caval anastomosis versus 48.3% (15/31) after other techniques (P = 0.003). Indirect signs of portal hypertension (PHT) before retransplantation were predictive of VVB requirement. Early and long-term outcomes were similar across the three groups (CP without VVB, CR without VVB, and VVB). Preserving the IVC in late ReLT is associated with better postoperative renal function and is facilitated by a previous 3-vein piggyback. Routine CR is not justified in late ReLT.

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Section: Discussionmentioning

confidence: 99%

Initial piggyback technique facilitates late liver retransplantation – a retrospective monocentric study

et al. 2021

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“…Various surgical techniques are used to reconstruct the hepatic venous outflow during liver transplant, with the two most common being conventional orthotopic liver transplant (OLT) and piggyback liver transplant (PBLT). 21 The choice of surgical technique has implications with respect to venous outflow complications, imaging diagnosis, and endovascular treatment approaches.…”

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confidence: 99%

“…Conventional OLT is utilized in the setting of whole liver DDLT. Operative technique involves complete hepatectomy with or without veno-venous bypass, and cross-clamping of the recipient retrohepatic IVC for resection and creation of new end-to-end caval anastomoses 21,22 (►Fig. 1).…”

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confidence: 99%

“…The PBLT technique shortens the anhepatic phase and obviates the need for veno-venous bypass by preserving the recipient IVC through the construction of a venous cuff between the recipient hepatic veins and the donor outflow venous tract. 21,[23][24][25][26] The most common iterations of this technique include a venous cuff incorporating the right hepatic vein and middle hepatic vein, the middle hepatic vein and left hepatic vein, or all three hepatic veins. 21,27 This venous cuff is then fashioned into an end-to-end 26 or side-to-side caval anastomosis 28,29 (►Fig.…”

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confidence: 99%

“…2), sometimes with an additional anastomosisenlarging cavotomy. 21,[30][31][32] PBLT is commonly performed in LDLT, split or reduced graft placement, and pediatric transplants, as anatomic variations and size mismatch between graft and recipient can make conventional technique difficult 33,34 Overall, HVOO is a rare complication of OLT. In adults, recent rates of HVOO vary between 1 and 4%, 5,[35][36][37] while historical rates vary widely and are reported to be between 0.5 and 13%.…”

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confidence: 99%

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Endovascular Treatment of Hepatic Venous Outflow Obstruction after Liver Transplant

2019

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Post liver transplant vascular complications can be categorized based on the location of the lesion within either the inflow or outflow vessels. Inflow lesions affect vascular supply via the transplant hepatic artery or portal vein and impact graft survival via ischemia. Outflow lesions involve the transplant hepatic veins and inferior vena cava (IVC), and affect graft survival via a phenomenon termed hepatic venous outflow obstruction (HVOO).Patients experiencing HVOO commonly present with congestive symptoms including ascites, pleural effusion, peripheral edema, abdominal pain, elevated liver enzymes, new onset splenomegaly, renal dysfunction, intestinal congestion, and, ultimately, fulminant graft dysfunction, hypotension, and multi-organ failure. 6-12 Mortality rates with HVOO have been reported up to 24%. 13,14 HVOO can be subdivided by time frame: early and late postoperative. Early postoperative phase HVOO occurs within 28 days of surgery and is typically secondary to surgical technical factors such as tight anastomotic sutures, kinking Keywords ► hepatic venous outflow obstruction ► liver transplant ► stent ► stenosis AbstractLiver transplantation provides definitive treatment to address acute or chronic endstage liver disease and its complications. Hepatic venous outflow obstruction is an infrequent complication of liver transplantation that affects graft survival by compromising outflow via transplant hepatic veins or inferior vena cava. It can occur in the early postoperative phase or in a delayed manner, resulting in venous congestion, graft dysfunction, graft failure, and death. This article addresses the pathophysiology of venous outflow obstruction as it relates to different surgical techniques and patient populations, the noninvasive tools for diagnosis, and the endovascular options for treatment along with their safety, efficacy, and durability.

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