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Hepatic venous outflow obstruction after whole liver transplantation of large-for-size graft: versatile intra-operative management
Ann Hepatobiliary Pancreat Surg 2018 Nov;22(4):321-5
Published online November 30, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Chetana Lim1, Michael Osseis1, Antonella Tudisco1, Eylon Lahat1, Dobromir Sotirov1, Chady Salloum1,  Daniel Azoulay1,2,3

1Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 2Université Paris-Est UPEC, Créteil, 3INSERM, U955, Créteil, France
Received February 6, 2018; Revised July 3, 2018; Accepted July 10, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Preservation of the native inferior vena cava using a large graft during adult whole liver transplantation is associated with a potential risk of hepatic venous outflow compression/obstruction, which may adversely affect both graft and short-term patient outcomes. Intraoperative placement of materials to restore adequate hepatic venous outflow can overcome this complication. 
Methods: Data of patients who underwent liver transplantation between 2011 and 2016 were retrospectively reviewed. All cases of hepatic venous outflow obstruction due to large graft size managed via intraoperative intervention were analyzed. The literature was searched for studies reporting adult cases of hepatic venous outflow obstruction following whole liver transplantation managed extrahepatically. 
Results: Three patients diagnosed with intraoperative hepatic venous outflow obstruction due to large graft size were managed via retro-hepatic placement of breast implants (2 cases) or abdominal pads (1 case). It was successfully carried out in all cases. Four studies including 15 patients were identified in the literature search. Different types of materials such as inflatable materials (Foley catheter, Blakemore balloon), surgical gloves or breast implants, were used. 
Conclusions: Placement of inflatable materials leads to gradual deflation in the postoperative period, which might obviate the need for reoperation. Breast implants could be left in place indefinitely due to their bio-inert nature.
Keywords : Hepatic venous outflow; Breast implants; Abdominal pads; Surgical gloves; Inflatable materials


November 2018, 22 (4)