INFERIOR VENA-CAVA OBSTRUCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Post-operative inferior vena cava (IVC) obstruction is reported as an uncommon complication after orthotopic liver transplantation (OLT). We report 6 cases after 245 OLT's in the period between March '79 and De cember '92. Compression or torsion of the IVC or a technical problem w ere underlying causes. Oligo-anuria was observed in almost all patient s and was probably caused by renal vein hypertension. Doppler ultrasou nd has become an important tool for the diagnosis of this complication . Operative treatment was performed in almost all cases in order to co rrect causative factors. Thrombi above or at the level of the upper an astomosis of the IVC should be removed via the right atrium, during ca rdio-pulmonary bypass, in order to prevent pulmonary embolism. Thrombi in the IVC caudal to the liver can be removed by cavotomy with high p ositive end expiratory pressure ventilation.