Tissue expanders – an innovative approach in the management of hepatic venous outflow obstruction after liver transplantation: A case report

Abstract

BACKGROUND

Hepatic venous outflow obstruction (HVOO) is a rare but serious complication of liver transplantation, particularly in piggyback liver transplantation techniques where the inferior vena cava (IVC) is preserved.

CASE SUMMARY

A transplanted liver patient underwent retransplantation due to hepatic artery thrombosis and subsequently developed HVOO caused by graft compression of the IVC. A novel approach using a retrohepatic tissue expander effectively relieved the IVC compression, restored venous outflow, and stabilized hemodynamics. We discuss this case in the context of current treatment options and advances in HVOO management, from endovascular interventions such as balloon dilation and stenting to innovative surgical solutions such as graft repositioning and retrohepatic implants.

CONCLUSION

This case shows how important personalized treatments are for managing HVOO and how tissue expanders can be an adjustable and less invasive option.

Keywords: Liver transplantation; Hepatic venous outflow obstruction; Tissue expander; Vascular complications; Case report

Core Tip: Hepatic venous outflow obstruction (HVOO) is a serious complication of liver transplantation, particularly with the piggyback technique where the inferior vena cava (IVC) is preserved. A unique approach using a retrohepatically placed tissue expander may successfully relieve IVC compression caused by graft malposition and stabilize hemodynamics without needing major surgery. This minimally invasive method demonstrates adjustable and effective decompression of the hepatic veins, suggesting a new therapeutic option for complex vascular complications after liver transplant. Our report highlights the importance of proactive monitoring and individualized interventions in managing HVOO to improve graft function and patient outcomes.