Supra Hepatic Inferior Vena Cava Thrombosis-Surgical Challenges

Area of Science:

• Nephrology
• Hepatology
• Transplantation Surgery

Background:

• Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a genetic disorder causing progressive liver and kidney cyst development, often leading to organ failure.
• Combined liver-kidney transplantation is a potential treatment for end-stage organ damage in ADPKD patients.
• Enlarged polycystic livers can compress the retrohepatic Inferior Vena Cava (IVC), complicating surgical planning and potentially causing intra-operative issues.

Observation:

• A 67-year-old female patient with a 16-year history of ADPKD presented with decompensated chronic liver disease and chronic kidney disease.
• The patient required renal replacement therapy and experienced liver decompensation post-surgery.
• Pre-operative imaging was challenging due to liver enlargement potentially obscuring the IVC.

Findings:

• The patient successfully underwent a combined deceased donor liver-kidney transplantation.
• Peri-operative management required modifications to the conventional surgical approach due to IVC compression.
• The case underscores the importance of anticipating and managing potential intra-operative complications in ADPKD transplant recipients.

Implications:

• This case highlights critical peri-operative considerations for combined liver-kidney transplantation in ADPKD patients with significant polycystic liver enlargement.
• Modified surgical strategies may be necessary to address Inferior Vena Cava (IVC) compression and ensure successful outcomes.
• Further literature review on managing these complex cases can improve clinical practice and patient care.