A classification for hepatic venous outflow obstruction after piggyback liver transplantation and its clinical significance

Objective A classification for hepatic venous outflow obstruction after piggyback liver transplantation (PBLT) and its clinical significance. Methods We conducted a retrospective study on 248 patients who underwent liver transplantation from May 2000 to August 2006. The aims were to elucidate the causes and treatment of postoperative venous outflow obstruction. Results Venous outflow obstruction occurred in 38 patients after transplantation. Among those, 2 (5.26%) had superior hepatic inferior vena cava (IVC) stenosis, 13 (34, 21%) had the hepatic vein anastomosis twisted at an angle, 7 (18.42%) had IVC stenosis at the posthepatic segment, and 16 (42.10%) had outflow obstruction at the hepatic veins. In these 38 patients, 34 underwent PBLT, 2 underwent APBLT, and 2 COLT. Most patients with hepatic venous outflow obstruction improved with surgical treatment and interventional therapy. Conclusions Hepatic vein outflow obstruction was associated with the technique of hepatic vein anastomosis, the type of cavocaval anastomosis and graft size mismatch between the donor and the recipient. Performing piggyback liver transplantation according to the classification of hepatic vein and appropriate treatments could improve the prognosis of venous outflow obstruction in clinical practice. Key words: Hepatic vein; Classification; Venous outflow obstruction; Liver transplantation