INFERIOR VENA-CAVA OBSTRUCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Post-operative inferior vena cava (IVC) obstruction is reported as an uncommon complication after orthotopic liver transplantation (OLT). We report 6 cases after 245 OLT's in the period between March '79 and December '92. Compression or torsion of the IVC or a technical problem were underlying causes. Oligo-anuria was observed in almost all patients and was probably caused by renal vein hypertension. Doppler ultrasound has become an important tool for the diagnosis of this complication. Operative treatment was performed in almost all cases in order to correct causative factors. Thrombi above or at the level of the upper anastomosis of the IVC should be removed via the right atrium, during cardio-pulmonary bypass, in order to prevent pulmonary embolism. Thrombi in the IVC caudal to the liver can be removed by cavotomy with high positive end expiratory pressure ventilation

Ex vivo MRI in extracorporeal liver surgery

Extracorporeal resection of hepatic tumors that were considered inoperable in the past is now possible in selected cases, Such procedures require high-quality preoperative images for the exact delineation of the tumor extent and for an optimal planning of the line of parenchymal division, In-vivo CT and MRI can not always depict the tumor adequately, In such cases, ex-vivo MRI may be a useful additional technique. It combines a high spatial resolution with the best possible soft tissue contrast, as was learned from previous studies on donor livers destined for transplantation. Ex-vivo MRI favours both a sufficiently radical resection as well as sufficient hepatic functional reserve to be present for reimplantation. A case history is reported together with details on the technical procedure.</p