Obstruction to hepatic venous drainage after liver transplantation: treatment with balloon angioplasty.

Stenosis of the suprahepatic inferior vena caval anastomosis is a rare but serious vascular complication after liver transplantation. It may cause significant obstruction to venous drainage from the allograft liver and result in the Budd-Chiari syndrome with massive ascites and pleural effusion causing respiratory compromise. The authors report two such cases in which percutaneous transluminal angioplasty (PTA) of the stenotic anastomosis was performed. This nonsurgical approach resulted in resolution of ascites, pleural effusion, and respiratory distress in both patients. They conclude that PTA is a therapeutic alternative with minimal risk compared with surgical repair or retransplantation and should be considered the initial treatment of choice in selected patients.