Abstract

Introduction: Hepatic venous outflow is an important for the graft survival in living donor liver transplantation. Hepatic venous outflow obstruction generates liver failure, which may influenced due to graft malposition, which unsized upper part of abdomen between donor and recipient. The number of Liver Transplantation (LT) increases last few years, which is related with populating the high surgical technology in developing country like in Mongolia. The main reason of LT is a hepatitis B virus-related liver cirrhosis in Mongolia. Liver transplantation had started since 2011 under the supporting of Professor Sung Gyu Lee from hepato-biliary surgery and liver transplantation of ASAN Medical Center. Veno-Occlusive Disease (VOD), Budd-Chiari Syndrome (BCS), and Congestive Hepatopathy (CH), all of which results in hepatic venous outflow obstruction. The early Hepatic Venous Outflow Obstruction (HVOO) is a rare, however that could raise a serious complication as a graft failure and eventual lose. We report a case of early HVOO, which may result of size mismatch of abdominal cavity. The size mismatch of abdominal cavity may produce kinking syndrome after transplantation of right lobe, which reveals the HVOO without anastomosis complication. Methods: A 38-year-old male patient with liver cirrhosis due to HBV, HDV, HCC in S8 of the liver (CTP-B, MELD-18). On the first postoperative day the patient developed impairment of the liver function. Doppler ultrasound (US) showed the different speed of RHV preanastomosis and postanastomosis field. This was diagnosed acute liver failure due to veno-oclusive disease, after that started intensive therapy.

Result: Kinking or twisting of the venous anastomosis is related with anatomical mismatch between the graft and the recipient abdomen, even though transplanted the right hemiliver graft. HVOO results acute cellular rejection, which treated by pulse therapy. However, it should be managed by surgically, put the tissue expander.

Conclusion: Doppler ultrasonography is one of the best choices to evaluate postoperative vascular complications in liver transplantation. The right hemiliver graft needs tissue expander for mismatching between the graft and recipient abdomen.