Late venous outflow obstruction after liver transplant: The 'piggy-back' syndrome.

Late hepatic vein and inferior vena cava obstruction after orthotopic liver transplant is unusual. Prolonged venous obstruction may lead to graft failure and reduced patient survival. Direct hepatic venography and pressure studies are essential for diagnosis. We described a patient who developed combined venous outflow obstruction 6 years after liver transplant and was successfully treated with metallic stent placement. Mechanical 'torsion' is a rare cause of venous outflow obstruction.