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Severe outflow block syndrome caused by compression by the swollen caudate lobe after living donor liver transplantation: report of a case

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Abstract

A 50-year-old man with primary biliary cirrhosis underwent living-donor liver transplantation (LDLT) using a graft of a left hemiliver with a left caudate lobe and duct-to-duct hepaticocholedochostomy. Postoperative bile leakage necessitated percutaneous drainage 22 days after LDLT. The patient presented to our hospital 205 days after the LDLT with abdominal distension and fever. Computed tomography showed ascites and a diffusely mottled pattern in the graft. The caudate lobe was swollen, and its bile ducts were dilated. The inferior vena cava was forced to the right by the swollen caudate lobe, and the root of the hepatic vein was stretched. The hepatic vein was not contrasted. Endoscopic retrograde cholangiography showed a biliary anastomotic stricture. Based on these findings, we diagnosed a severe outflow block of the hepatic vein and biliary anastomotic stricture. We performed balloon dilation of the biliary anastomosis and implanted a metallic stent in the hepatic vein. Thereafter, his clinical symptoms improved dramatically.

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References

  1. Miyagawa S, Hashikura Y, Miwa S, Ikegami T, Urata K, Terada M, et al. Concomitant caudate lobe resection as an option for donor hepatectomy in adult living related liver transplantation. Transplantation. 1998;66:661–3.

    Article  PubMed  CAS  Google Scholar 

  2. Yagi S, Iida T, Taniguchi K, Hori T, Hamada T, Fujii K, et al. Impact of portal venous pressure on regeneration and graft damage after living-donor liver transplantation. Liver Transpl. 2005;11:68–75.

    Article  PubMed  Google Scholar 

  3. Yoshimura N, Okajima H, Ushigome H, Sakamoto S, Fujiki M, Okamoto M. Current status of organ transplantation in Japan and worldwide. Surg Today. 2010;40:514–25.

    Article  PubMed  Google Scholar 

  4. Sugawara Y, Makuuchi M, Takayama T, Imamura H, Dowaki S, Mizuta K, et al. Small-for-size grafts in living-related liver transplantation. J Am Coll Surg. 2001;192:510–3.

    Article  PubMed  CAS  Google Scholar 

  5. Kubota K, Takayama T, Sano K, Hasegawa K, Aoki T, Sugawara Y, et al. Small bile duct reconstruction of the caudate lobe in living-related liver transplantation. Ann Surg. 2002;235:174–7.

    Article  PubMed  Google Scholar 

  6. Takada Y, Ueda M, Ishikawa Y, Fujimoto Y, Miyauchi H, Ogura Y, et al. End-to-side portocaval shunting for a small-for-size graft in living donor liver transplantation. Liver Transpl. 2004;10:807–10.

    Article  PubMed  Google Scholar 

  7. Kokudo N, Sugawara Y, Kaneko J, Imamura H, Sano K, Makuuchi M. Reconstruction of isolated caudate portal vein in left liver graft. Liver Transpl. 2004;10:1163–5.

    Article  PubMed  Google Scholar 

  8. Ishiko T, Egawa H, Kasahara M, Nakamura T, Oike F, Kaihara S, et al. Duct-to-duct biliary reconstruction in living donor liver transplantation utilizing right lobe graft. Ann Surg. 2002;236:235–40.

    Article  PubMed  Google Scholar 

  9. Cescon M, Grazi GL, Varotti G, Ravaioli M, Ercolani G, Gardini A, et al. Venous outflow reconstructions with the piggyback technique in liver transplantation: a single-center experience of 431 cases. Transpl Int. 2005;18:318–25.

    Article  PubMed  Google Scholar 

  10. Shin JH, Sung KB, Yoon HK, Ko GY, Kim KW, Lee SG, et al. Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft. Liver Transpl. 2006;12:269–76.

    Article  PubMed  Google Scholar 

  11. Kawano Y, Akimaru K, Taniai N, Yoshida H, Yokomuro S, Mamada Y, et al. Successful transjugular balloon dilatation of the hepatic vein stenosis causing hypoalbuminemia after pediatric living-donor liver transplantation. Hepatogastroenterology. 2007;54:1821–4.

    PubMed  Google Scholar 

  12. Marubashi S, Dono K, Nagano H, Kobayashi S, Takeda Y, Umeshita K, et al. Biliary reconstruction in living donor liver transplantation: technical invention and risk factor analysis for anastomotic stricture. Transplantation. 2009;88:1123–30.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Mr. C.W.P. Reynolds for linguistic assistance with this manuscript.

Conflict of interest

Kazuhisa Takeda and his coauthors have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Kazuhisa Takeda, Kuniya Tanaka, Takafumi Kumamoto, Akimitsu Yamada, Michiyo Yamada, Hideki Takakura & Itaru Endo

  2. Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Kensuke Kubota & Noritoshi Kobayashi

  3. Department of Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Jin Lee

Authors
  1. Kazuhisa Takeda
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  2. Kuniya Tanaka
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  3. Takafumi Kumamoto
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  4. Akimitsu Yamada
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  5. Michiyo Yamada
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  6. Hideki Takakura
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  7. Kensuke Kubota
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  8. Noritoshi Kobayashi
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  9. Jin Lee
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  10. Itaru Endo
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Correspondence to Kazuhisa Takeda.

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Takeda, K., Tanaka, K., Kumamoto, T. et al. Severe outflow block syndrome caused by compression by the swollen caudate lobe after living donor liver transplantation: report of a case. Surg Today 42, 177–180 (2012). https://doi.org/10.1007/s00595-011-0037-0

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  • DOI: https://doi.org/10.1007/s00595-011-0037-0

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