Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2025; 13(29): 108608
Published online Oct 16, 2025. doi: 10.12998/wjcc.v13.i29.108608
Tissue expanders – an innovative approach in the management of hepatic venous outflow obstruction after liver transplantation: A case report
Igor Petrovic, Klara Brekalo, Ivan Romic, Hrvoje Silovski, Vibor Sesa, Ruzica Galunic Cicak, Kresimir Bulic, Oliver M Koltay, Iva Martina Strajher, Anna Mrzljak
Igor Petrovic, Hrvoje Silovski, Department of Hepatobiliary Surgery and Transplantation, University Hospital Center Zagreb, University of Zagreb, Medical school Zagreb, Zagreb 10000, Croatia
Klara Brekalo, Department of Surgery, University of Zagreb School of Medicine, Zagreb 10000, Croatia
Ivan Romic, Iva Martina Strajher, Department of Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
Vibor Sesa, Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
Ruzica Galunic Cicak, Department of Radiology, University Hospital Center Zagreb, Zagreb 10000, Croatia
Kresimir Bulic, Department of Plastic Surgery, University Hospital Center Zagreb, University of Zagreb, Medical school Zagreb, Zagreb 10000, Croatia
Oliver M Koltay, University of Zagreb School of Medicine, Zagreb 10000, Croatia
Anna Mrzljak, Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb, Medical school Zagreb, Zagreb 10000, Croatia
Co-first authors: Igor Petrovic and Klara Brekalo.
Co-corresponding authors: Ivan Romic and Anna Mrzljak.
Author contributions: Petrovic I and Brekalo K contributed to manuscript writing, editing and data collection; Romic I, Silovski H, and Bulic K contributed to literature review and interpretation of findings; Sesa V, Cicak Galunic R, Koltay OM, and Strajher IM contributed to clinical data analysis; Mrzljak A contributed to conceptualization and supervision. All authors have read and approved the final manuscript. Petrovic I and Brekalo K contributed equally to this manuscript and are co-first authors. Both Romic I and Mrzljak A have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Romic I conceptualized, designed and supervised the whole process of the project. Mrzljak A was instrumental and responsible for data re-analysis and re-interpretation, figure plotting, comprehensive literature search, preparation and submission of the current version of the manuscript. This collaboration between Romic I and Mrzljak A is crucial for the publication of this manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anna Mrzljak, MD, PhD, Professor, Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, University of Zagreb, Medical school Zagreb, 12 Kispaticeva Street, Zagreb 10000, Croatia. anna.mrzljak@gmail.com
Received: April 18, 2025
Revised: May 27, 2025
Accepted: July 29, 2025
Published online: October 16, 2025
Processing time: 132 Days and 10.7 Hours
Abstract
BACKGROUND

Hepatic venous outflow obstruction (HVOO) is a rare but serious complication of liver transplantation, particularly in piggyback liver transplantation techniques where the inferior vena cava (IVC) is preserved.

CASE SUMMARY

A transplanted liver patient underwent retransplantation due to hepatic artery thrombosis and subsequently developed HVOO caused by graft compression of the IVC. A novel approach using a retrohepatic tissue expander effectively relieved the IVC compression, restored venous outflow, and stabilized hemodynamics. We discuss this case in the context of current treatment options and advances in HVOO management, from endovascular interventions such as balloon dilation and stenting to innovative surgical solutions such as graft repositioning and retrohepatic implants.

CONCLUSION

This case shows how important personalized treatments are for managing HVOO and how tissue expanders can be an adjustable and less invasive option.

Keywords: Liver transplantation; Hepatic venous outflow obstruction; Tissue expander; Vascular complications; Case report

Core Tip: Hepatic venous outflow obstruction (HVOO) is a serious complication of liver transplantation, particularly with the piggyback technique where the inferior vena cava (IVC) is preserved. A unique approach using a retrohepatically placed tissue expander may successfully relieve IVC compression caused by graft malposition and stabilize hemodynamics without needing major surgery. This minimally invasive method demonstrates adjustable and effective decompression of the hepatic veins, suggesting a new therapeutic option for complex vascular complications after liver transplant. Our report highlights the importance of proactive monitoring and individualized interventions in managing HVOO to improve graft function and patient outcomes.