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B. Jawan, H. K. Cheung, C. C. Chen, Y. S. Chen, Y. C. Chiang, C. C. Wang, Y. F. Cheng, T. L. Huang, H. L. Eng, S. Goto, T. L. Pan, V. De Villa, P. P. Liu, S. H. Wang, C. L. Lin and J. H. Lee, “Repeated Hypotensive Episodes Due to Hepatic Outflow Obstruction during Liver Transplantation in Adult Patients,” Journal of Clinical Anesthesia, Vol. 12, No. 3, 2000, pp. 231-233. http://dx.doi.org/10.1016/S0952-8180(00)00146-X

has been cited by the following article:

• TITLE: A Simple and New Device to Avoid Hepatic Venous Outflow Obstruction in Adult Liver Transplantation

  AUTHORS: Dino Donataccio, Salvatore Grosso, Matteo Donataccio

  KEYWORDS: Outflow Obstruction, Allograft Malposition, Liver Transplantation, Surgical Glove Expander, Device

  JOURNAL NAME: Surgical Science, Vol.2 No.10, December 9, 2011

  ABSTRACT: Hepatic venous drainage in liver transplantation may be reduced to the level of caval anastomosis producing an obstruction degree and leading to serious vascular complication such as the acute Budd-Chiari syndrome, which may result in organ loss. Outflow obstruction may be caused by lack of technique in caval anastomosis or by allograft malposition as a consequence of anatomical graft and recipient conditions. Fixation of the round ligament, placement of bowel loops and use of tissue expanders have been described to stabilize graft position during liver transplantation with related procedure complications. We report our experience of a simple homemade device using a surgical glove expander that allowed us to successfully avoid outflow obstruction in all of nine treated patients. No device related complications occurred. In malposed liver allografts, we strongly suggest the use of this simple and safe device to avoid hepatic venous outflow obstruction on condition that the device is early removed within 48 hours.