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Published on: August 17, 2022
Living-Donor Liver Transplantation for Budd-Chiari Syndrome: Case Series
C Karaca1, C Yilmaz2, R Ferecov2
1Department of General Surgery, Izmir University of Economics, Faculty of Medicine, Izmir, Turkey.
Insights
Living-donor liver transplantation offers a viable solution for Budd-Chiari syndrome (BCS). Venous reconstruction techniques, including de novo orifices and direct anastomosis, enable successful liver transplants in BCS patients.
Area of Science:
- Hepatology
- Transplant Surgery
- Vascular Surgery
Background:
- Budd-Chiari syndrome (BCS) presents unique challenges for venous reconstruction in living-donor liver transplantation.
- Graft limitations and compromised inferior vena cava (IVC) necessitate specialized anastomotic techniques.
- Existing methods for IVC reconstruction in BCS are varied, with limited data on their efficacy.
Purpose of the Study:
- To evaluate the feasibility and outcomes of venous reconstruction strategies in living-donor liver transplantation for BCS.
- To present surgical techniques employed to overcome IVC challenges in BCS liver transplantation.
- To assess the safety and success of different venous reconstruction methods in a cohort of BCS patients.
Main Methods:
- Retrospective analysis of medical records from 22 patients undergoing living-donor liver transplantation for BCS.
- Detailed review of surgical techniques used for venous reconstruction, focusing on IVC management.
- Categorization of patients based on IVC condition (stenosed/thrombosed) and reconstruction method.
Main Results:
- A wide, triangular de novo orifice was the primary technique for venous drainage in 19 patients.
- For completely thrombosed IVC, direct anastomosis to the supra-hepatic IVC was performed in 2 patients.
- Anastomosis to the right atrium was utilized in one patient with a totally thrombosed IVC.
Conclusions:
- Venous reconstruction in BCS liver transplantation can be successfully achieved without patch-plasty.
- Safe resection of the IVC is feasible in selected BCS patients undergoing liver transplantation.
- Living-donor liver transplantation is a practical treatment option for BCS, especially given the donor organ shortage.
Background:
Venous reconstruction in living-donor liver transplantation for Budd-Chiari syndrome (BCS) has challenges because the grafts from living donors lack vena cava, and hepatic venous anastomosis must be performed on an already-thrombosed and/or stenosed inferior vena cava. Several techniques are described to overcome this problem, and we represent our experience with 22 patients.
Methods:
Medical recordings of 22 patients were retrospectively collected, and disease-specific data as well as recordings about surgical technique were analyzed.
Results:
Creation of a wide, triangular de novo orifice was the main method used for venous drainage, which was used in 19 patients. The remaining 3 patients had totally thrombosed vena cava; thus, direct anastomosis to the supra-hepatic portion of the vena cava was used in 2 patients and an anastomosis to the right atrium was used in 1 patient.
Conclusions:
Venous reconstruction in BCS can be achieved without the use of patch-plasty, and the inferior vena cava can be safely resected in selected patients. Living-donor liver transplantation is a feasible option for the treatment of BCS, considering the scarcity of cavaderic donors.
