Venous complications after orthotopic liver transplantation

Complications involving the portal vein or the vena cava, are rare after or thotopic liver transplantation. We report on the incidence and treatment of venous complications following 1000 orthotopic liver transplantations in 9 11 patients. Twenty-six of the adult patients (2.7%) suffered from portal c omplications after transplantation, whereas complications of the vena cava were observed in only 17 patients (1.8%). Technical problems or recurrence of the underlying disease (e.g. Budd-Chiari syndrome) accounted for the maj ority of complications of the vena cava, whereas alteration of the vessel w all or splenectomy during transplantation could be identified as important risk factors for portal vein complications. In patients undergoing modifica tion of the standard end-to-end veno-venous anastomosis of the portal vein due to pathological changes of the vessel wall, complications occurred in 8 .3%, whereas only 2.4% of patients who received a standard anastomosis of t he portal vein experienced complications of the portal vein. Furthermore, s plenectomy during transplantation was also associated with an increased inc idence of portal vein complications (10.5 vs. 2.2% in patients without sple nectomy). Treatment was dependent on the signs and symptoms of the patients , and varied considerably between patients with portal vein complications a nd patients suffering from complications of the vena cava. Complications of the vena cava led to retransplantation in about one-third of the patients, whereas in patients with occlusion of the portal vein, retransplantation w as necessary in only 15%, and more than half of the patients suffering from portal vein complications did nor require any treatment at all. Usually, t reatment of patients with portal vein complications only became necessary w hen additional complications such as arterial occlusion or bile duct injuri es occurred.