Suah Ashley, Millis J Michael, Bodzin Adam S
Department of Surgery, Section of Abdominal Organ Transplantation, University of Chicago, Chicago, IL, USA.
Hepatobiliary Surg Nutr. 2018 Feb;7(1):29-31. doi: 10.21037/hbsn.2017.01.05.
Congenital membranous occlusion of the inferior vena cava (IVC) in pediatric liver recipients may present with outflow occlusion and if unrecognized, result in graft loss. Prompt evaluation of outflow obstruction in the setting of unexplained inflow compromise is paramount. We report a case of successful IVC reconstruction in a patient with recurrent hepatic artery thrombosis (HAT). A 2-year-old child with history of two liver transplantations developed fevers, ascites, and abdominal tenderness one month after her second liver transplant. Hepatic duplex revealed decreased flow in the hepatic artery and IVC venogram revealed patent hepatic veins with occlusion of the suprahepatic IVC. We performed reconstruction of her suprahepatic IVC to intrapericardial IVC using an end-to-side technique after complete mobilization of the liver. Recovery was uneventful and the patient has been doing well for the last 5 years.
小儿肝移植受者先天性下腔静脉（IVC）膜性闭塞可能表现为流出道梗阻，若未被识别，可导致移植物丢失。在出现无法解释的流入道受损情况时，迅速评估流出道梗阻至关重要。我们报告一例复发性肝动脉血栓形成（HAT）患者成功进行下腔静脉重建的病例。一名有两次肝移植史的2岁儿童在第二次肝移植后1个月出现发热、腹水和腹部压痛。肝脏双功超声显示肝动脉血流减少，IVC静脉造影显示肝静脉通畅但肝上段IVC闭塞。我们在完全游离肝脏后，采用端侧技术将其肝上段IVC重建至心包内IVC。恢复过程顺利，患者在过去5年一直状况良好。
