Tissue expanders – an innovative approach in the management of hepatic venous outflow obstruction after liver transplantation: A case report

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.