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Stent Placement for Treating IVC Stenosis Following “Left at Right” Adult Liver Transplantation

We read with great interest the paper by Chan et al (1) reporting ‘‘left at right’’ adult liver transplantation (LAR-LT): the feasibility of heterotopic implantation of left liver (LL) graft. The authors reported that this newprocedure enables the anastomosis of portal vein, hepatic vein, hepatic artery and biliary duct to be performed smoothly without any tension. We applied this procedure for the consecutive three recipients using LL graft plus caudate lobe (CL). Actually, every anastomosiswas easy to perform; however, all of them needed to undergo stent placement for the stenosis of the inferior vena cava (IVC) cranial to the anastomosis of hepatic vein. Case: Sixty-four-year-old male underwent LAR-LT for hepatitis B with hepatocellular carcinoma (HCC). His graft recipient weight ratio (GRWR) was 0.74, and the model for end-stage liver disease (MELD) score was 11. On postoperative day (POD) 11, the ascetic fluid volume increased up to more than 2500 mL, and a Doppler ultrasound examination revealed flat waveforms and slightly low flow velocities in hepatic vein. A CT scan showed compression and stretch of the IVC by the regenerated grafted liver parenchyma (Figure 1A and B). The hepatic venograph showed no evidence of stenosis, but IVC stenosis was visualized cranial to the anastomosis of hepatic vein by venacavography and there was a pressure gradient of 13 mmHg (Figure 1C). A 30-mm-diameter, 5-cm-long Cook-Z stent