PMC6172939_01
Evolution of serum creatinine (plain line) after orthotopic liver transplantation.. Note. Dotted line represents urinary sodium concentration. PC = paracentesis to drain ascites; IVC = inferior vena cava.
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He developed AKI (KDIGO stage 2: >100% increase in serum creatinine) after the surgery (Figure 1) but renal function subsequently partially improved with serum creatinine between 130 and 155 micromol/L during the month following surgery.
(a) Doppler ultrasound evaluation of the hepatic venous flow 58 days after surgery. (b) Carbon monoxide angiogram 65 days after liver transplantation showing a stenosis (arrow) of the distal cavocaval anastomosis. A significant pressure gradient of 12 mm Hg was measured across the stenosis. (c) Balloon dilatation and subsequent stent placement (not shown). (d) Doppler ultrasound evaluation of the hepatic vein flow at 24 hours after stent placement.. Note. IVC = inferior vena cava.
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The continued presence of significant ascites accumulation and persistent kidney dysfunction led to a repeated Doppler ultrasound evaluation which still revealed monophasic hepatic vein flow (Figure 2a). A severe stenosis of the distal cavocaval anastomosis located downstream of the hepatic veins associated with a trans-stenotic gradient of 12 mm Hg was demonstrated (Figure 2b). Vena cava angioplasty followed by stent placement (20 mm x 50 mm Gianturco Z-stent (Cook medical, Bloomington, Indiana) was performed (Figure 2c) with good angiographic result and no residual gradient or complication. Doppler ultrasound evaluation of the liver showed normalization hepatic veins flow, both 24 hours after angioplasty and 7 days after (Figure 2d).