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Related Experiment Video

Updated: May 20, 2026

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
12:27

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt

Published on: May 7, 2015

Devastating outflow obstruction after pediatric split liver transplantation.

Seisuke Sakamoto1, Atsuko Nakazawa, Takanobu Shigeta

  • 1Division of Transplantation, National Center for Child Health and Development, Tokyo, Japan. sakamoto-si@ncchd.go.jp

Pediatric Transplantation
|July 19, 2012
PubMed
Summary

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Hepatic venous outflow obstruction (HVOO) is a rare complication after pediatric liver transplants (LT). This case highlights how sinusoidal obstruction syndrome (SOS) can cause severe graft failure, even with mechanical obstruction treatment.

Area of Science:

  • Hepatology
  • Pediatric Surgery
  • Transplantation Immunology

Background:

  • Pediatric liver transplantation (LT) can be complicated by hepatic venous outflow obstruction (HVOO).
  • Causes of HVOO include mechanical issues and sinusoidal obstruction syndrome (SOS).

Observation:

  • A 10-month-old infant with acute liver failure (ALF) underwent a deceased donor split LT.
  • Postoperative recovery was initially normal, but liver function declined one month later.
  • Liver biopsy showed centrilobular injury, and Doppler ultrasonography (D-US) indicated outflow obstruction.

Findings:

  • Venography revealed hepatic venous narrowing within the graft.
  • Despite successful venoplasty and stenting, the graft failed progressively.
  • Pathological examination of the explanted graft showed necrosis due to SOS, not anastomotic stricture.

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Last Updated: May 20, 2026

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
12:27

Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt

Published on: May 7, 2015

Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection
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Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection

Published on: December 30, 2025

Implications:

  • SOS can lead to severe consequences in pediatric LT patients.
  • Concomitant SOS and mechanical outflow obstruction pose a significant risk for graft failure.
  • This case underscores the importance of considering SOS in unexplained graft dysfunction post-LT.