Related Experiment Video
Updated: Jun 16, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Hepatic venous outflow obstruction in paediatric liver transplantation
G Krishna Kumar1, Khalid Sharif, David Mayer
1Liver Unit, Birmingham Children's Hospital, Birmingham, UK. sasisang@rediffmail.com
Insights
Hepatic venous outflow obstruction (HVOO) is a serious complication after pediatric liver transplants. Early diagnosis with venography and specific surgical techniques can improve outcomes and reduce mortality.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Vascular Surgery
Background:
- Vascular complications, specifically hepatic venous outflow obstruction (HVOO), pose significant risks following pediatric orthotopic liver transplantation.
- These complications can lead to severe post-operative morbidity.
Purpose of the Study:
- To investigate the incidence, presentation, and management of hepatic venous outflow obstruction (HVOO) in children undergoing liver transplantation.
- To identify risk factors and optimal surgical techniques to prevent and treat HVOO.
Main Methods:
- A retrospective review of pediatric liver transplant recipients between 2004 and 2006 was conducted.
- Data analysis included proforma-based information on patient demographics, surgical techniques, post-operative complications, and diagnostic/therapeutic interventions.
Main Results:
- Seven out of 106 liver transplants (6.6%) developed hepatic venous outflow obstruction (HVOO).
- Ascites was the most common post-operative manifestation. Doppler ultrasonography aided diagnosis, while venography confirmed obstruction and guided therapy.
- Intervention via venography and dilatation in 5/7 cases resulted in 3 successful outcomes; 2 patients died without intervention, and 1 died awaiting retransplantation.
Conclusions:
- A high index of suspicion is crucial for early diagnosis of HVOO, necessitating prompt venography for successful management.
- Preventative surgical strategies include ensuring a short, wide hepatic vein-caval anastomosis with triangulation and avoiding graft rotation.
Introduction:
Vascular complications after orthotopic split liver transplantation in children result in significant post-operative complications.
Materials And Methods:
A review of children undergoing liver transplantation from 2004 to 2006 was undertaken. The data was obtained based on a proforma-based analysis.
Results:
Seven of 106 transplants were identified to have hepatic venous outflow obstruction (HVOO) of whom five were males and two were females. Median age at transplant was 8 years (range 3 years 4 months-15 years). The median donor-to-recipient weight ratio was 2.78 (range 0.97-6.15). ANASTOMOTIC TECHNIQUE: Hepatic vein-IVC in four, Hepatic vein-hepatic vein (HV-IVC) confluence in two and cavo hepatic in one. Ascites was the commonest post op manifestation of HVOO. Although Doppler USG was useful in identifying the venous outflow obstruction, venography confirmed the exact site of obstruction aiding in therapeutic dilatation. Three of seven cases had early onset (<1 month) while 4/7 had late onset (>1 month). 5/7 underwent venography and dilatation, of whom three are well and one is awaiting a repeat venography and dilatation. 2/7 died without intervention and 1/7 died in the waiting list for retransplantation.
Conclusion:
The diagnosis of HVOO requires a high index of suspicion, prompting early venography to manage HVOO successfully. Technical steps to avoid HVOO are to keep the hepatic vein-caval anastomosis short and wide with triangulation and to avoid graft rotation at the hepato caval junction.
