Early venous outflow obstruction after liver transplantation and treatment with cavo-cavostomy.

OBJECTIVE

The objective of this study was to describe by a retrospective analysis the evolution of patients who needed an end-to side cavo-cavostomy in addition to a previous cavo-caval anastomosis, during orthotopic liver transplantation (OLT), caused by hepatic venous outflow obstruction.

METHODS

We reviewed 673 consecutive OLT and the treatment and evolution of technique-related complications.

RESULTS

This study of 673 consecutive OLT, all with the piggyback modality included 23 cases (22 patients and 23 grafts) who underwent an additional cavo-caval anastomosis for venous outflow problems either perioperatively or during the immediate postoperative period. One patient developed an early and 3 developed a late, caval stenosis that was successfully treated using angioplasty. Five patients died postoperatively. Causes of death were sepsis (n = 3), thrombosis of a mesenteric bypass (n = 1), and massive hemorrhage (n = 1). Long time evolution was as follows: 2 patients died at 7 and 45 months, respectively, (viral relapse) and the other 15 subjects are alive and well.