Endovascular treatment of hepatic venous outflow obstruction after piggyback technique liver transplantation

Background. The piggyback technique of orthotopic Liver transplantation is an attractive alternative that preserves the recipient inferior vena cava a nd allows uninterrupted venous blood return during the anhepatic phase. As with other transplantation techniques, the vascular anastomoses required by the piggyback technique can develop strictures. Methods. Review of records of 264 piggyback transplantations revealed two c ases of delayed-onset hepatic venous obstruction from anastomotic stricture s. Both patients also had symptoms of inferior vena cava obstruction, with azotemia and lower extremity edema. Both patients were treated percutaneous ly with balloon-expandable stents. Results. Rapid, dramatic resolution of symptoms was achieved in both patien ts. Patients remain completely asymptomatic at 39 and 3 months of follow-up . Conclusions. Hepatic venous anastomotic strictures in recipients of piggyba ck technique transplants are a very uncommon complication. They may be easi ly and effectively treated by minimally invasive endovascular intervention.