scholarly journals P-L17 Post-liver transplant inferior vena cava stenosis in a large volume UK centre

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Harry VM Spiers ◽  
Fanourios Georgiades ◽  
Ciara Walker ◽  
James Ashcroft ◽  
Foad Rouhani ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Anastomotic Stricture ◽  
Rare Complication ◽  
Vena Cava ◽  
Liver Transplants ◽  
Replacement Technique ◽  
Normothermic Machine Perfusion ◽  
Vena Cava Stenosis

Abstract Background Inferior vena cava stenosis (IVCS) is a rare complication of liver transplantation with a reported incidence rate of 3%. Limited clinical consensus exists on the management of IVCS. We report the management and outcomes of patients with IVCS at our transplant centre.  Methods Relevant data were collected from adult patients who underwent liver transplantation at our centre between October 2014 and August 2020. These included demographics, investigation and management details with regards to IVCS. Values presented as % of total and median with interquartile range (IQR).  Results A total of 636 liver transplants were performed during the study period, of which 48 (7.6%) patients were investigated for possible IVCS. Of those, 14 (2.2% of total) were found to have IVCS, 85.7% (n = 12) were female. Only 2/14 were re-transplants and pre-transplant portal vein thrombus was present in 3 cases (21.4%). 10 livers (71.4%) were DBD donors. Normothermic machine perfusion was used in 4/14 patients. All 14 recipients found to have IVCS had had an implantation using a modified piggyback cavocavostomy technique. The IVCS was identified at a median of 25.5 days (19.7-30.8 days) following transplantation within the suprahepatic IVC in 92.9% (n = 13). Hemi-azygos collateralisation was seen in 4 cases (28.6%). 8 of the 14 recipients underwent intervention for IVCS, 6 patients were managed with balloon venoplasty, 1 patient required an IVC stent and 1 was managed surgically. Six of the recipients with IVCS died, 4 of whom had an intervention for their stenosis and 3 of these were within 90 days of their transplant. Pressures measured at the anastomotic stricture were higher in those who succumbed (median of 21 Vs 12.5 mmHg; p=.017).  Conclusions At our centre, cava-replacement technique was not associated with IVCS. Patients with more significant strictures (as evidenced by higher pressures at the anastomotic stenosis) may have an increased mortality risk.

scholarly journals Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation

2016 ◽  
Vol 20 (3) ◽  
pp. 133 ◽  
Author(s):  
Batsaikhan Bat-Erdene ◽  
Sergelen Orgoi ◽  
Erdene Sandag ◽  
Ulzii-Orshikh Namkhai ◽  
Bat-Ireedui Badarch ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Inferior Vena Cava ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Vena Cava Stenosis

scholarly journals Long-term efficacy of stent placement for treating inferior vena cava stenosis following liver transplantation

2010 ◽  
Vol 16 (4) ◽  
pp. 513-519 ◽  
Author(s):  
Jae Myeong Lee ◽  
Gi-Young Ko ◽  
Kyu-Bo Sung ◽  
Dong Il Gwon ◽  
Hyun-Ki Yoon ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Inferior Vena Cava ◽  
Stent Placement ◽  
Inferior Vena ◽  
Vena Cava ◽  
Term Efficacy ◽  
Vena Cava Stenosis

Nodular Regenerative Hyperplasia after Liver Transplantation Complicated with Inferior Vena Cava Stenosis: a Clue for Etiopathogenesis?

2015 ◽  
Vol 24 (3) ◽  
pp. 383-385 ◽  
Author(s):  
Rosa Coelho ◽  
Susana Rodrigues ◽  
Eduardo Rodrigues-Pinto ◽  
Roberto Silva ◽  
Joanne Lopes ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Liver Parenchyma ◽  
Nodular Regenerative Hyperplasia ◽  
Peripheral Edema ◽  
Endovascular Prosthesis ◽  
Regenerative Nodules ◽  
Vena Cava Stenosis

Nodular regenerative hyperplasia is a histopathological diagnosis characterized by the diffuse transformation of the liver parenchyma into regenerative nodules associated with rheumatologic and hematologic disorders, azathioprine immunosuppression or vascular injuries. The authors report the case of a 60-year-old female patient with a diagnosis of familial systemic paramyloidosis submitted to liver transplantation complicated by a hepatic artery thrombosis. A second liver transplant was performed and after 6 months she developed ascites and peripheral edema. The abdominal computed tomography (CT) showed an inferior vena cava stenosis. She underwent balloon angioplasty and an endovascular prosthesis was placed. The patient remained asymptomatic under immunosuppression with tacrolymus for 4 years, when she complained of peripheral edema and ascites. Laboratory work-up showed anemia and hypoalbuminemia with liver chemistry within the normal range. The ascites fluid analysis revealed a serum ascites albumin gradient superior to 1.1 g/L. Abdominal Doppler ultrasound and abdominopelvic CT angiogram confirmed endovascular prosthesis permeability. A percutaneous hepatic biopsy specimen was taken and histologic analysis showed, with reticulin stain, focal regenerative nodules of hyperplastic hepatocytes and internodular hepatocyte atrophy, compatible with the diagnosis of nodular regenerative hyperplasia. The case described is of particular interest as the nodular regenerative hyperplasia occurred after liver transplantation complicated with inferior vena cava stenosis, which might have contributed in a crucial way to liver parenchyma transformation.

Stent Migration Complicating Treatment of Inferior Vena Cava Stenosis after Orthotopic Liver Transplantation

2005 ◽  
Vol 16 (9) ◽  
pp. 1247-1252 ◽  
Author(s):  
Marcelo Guimarães ◽  
Renan Uflacker ◽  
Claudio Schönholz ◽  
Christopher Hannegan ◽  
J. Bayne Selby
Keyword(s):  
Liver Transplantation ◽  
Inferior Vena Cava ◽  
Orthotopic Liver Transplantation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Stent Migration ◽  
Vena Cava Stenosis

scholarly journals Sequential Venoplasty for Treatment of Inferior Vena Cava Stenosis Following Liver Transplant

2014 ◽  
Vol 4 ◽  
pp. 50 ◽  
Author(s):  
Ahmad Parvinian ◽  
Ron Charles Gaba
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Hepatic Dysfunction ◽  
Rare Complication ◽  
Balloon Dilation ◽  
Vena Cava ◽  
Vascular Lesions ◽  
First Line ◽  
Benign Biliary Strictures ◽  
Vena Cava Stenosis

Obstruction of the inferior vena cava (IVC) is a rare complication of liver transplantation with significant consequences including intractable ascites and hepatic dysfunction. Although venoplasty and stenting are effective in many cases, patients who fail first-line treatment may require surgical intervention or re-transplantation. Scheduled sequential balloon dilation, an approach frequently used to treat fibrotic, benign biliary strictures, but less commonly vascular lesions, may avert the need for such high-risk alternatives while achieving favorable clinical and angiographic response. Herein, we report the case of a 36-year-old woman with transplant-related, initially angioplasty-resistant IVC stenosis that was successfully treated with sequential balloon dilation.

scholarly journals Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Anas Abudan ◽  
Brent Kidd ◽  
Peter Hild ◽  
Bhanu Gupta
Keyword(s):  
Inferior Vena Cava ◽  
Heart Transplantation ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Case Series ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Orthotopic Heart Transplantation ◽  
Eustachian Valve

Abstract Background Inferior vena cava (IVC) obstruction is a rare complication of orthotopic heart transplantation (OHT) and is unique to bicaval surgical technique. The clinical significance, diagnosis, complications, and management of post-operative IVC anastomotic obstruction have not been adequately described. Case summary Two patients with end-stage heart failure presented for bicaval OHT. Post-operative course was complicated with shock refractory to fluid resuscitation and inotropic/vasopressor support. Obstruction at the IVC-right atrial (RA) anastomosis was diagnosed on transoesophageal echocardiography (TOE), prompting emergent reoperation. In both cases, a large donor Eustachian valve was found to be restricting flow across the IVC-RA anastomosis. Resection of the valve resulted in relief of obstruction across the anastomosis and subsequent improvement in haemodynamics and clinical outcome. Discussion Presumably rare, we present two cases of IVC obstruction post-bicaval OHT. Inferior vena cava obstruction is an under-recognized cause of refractory hypotension and shock in the post-operative setting. Prompt recognition using TOE is crucial for immediate surgical correction and prevention of multi-organ failure. Obstruction can be caused by a thickened Eustachian valve caught in the suture line at the IVC anastomosis, which would require surgical resection.

Can Coronary Vein Size Predict Hemodynamic Instability During Inferior Vena Cava Clamping in Liver Transplantation?

2014 ◽  
Vol 46 (3) ◽  
pp. 692-695 ◽  
Author(s):  
C.-E. Huang ◽  
S.-C. Yang ◽  
C.-L. Chen ◽  
Y.-F. Cheng ◽  
K.-W. Cheng ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Hemodynamic Instability ◽  
Coronary Vein
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