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Hepatic transplantation with perioperative and long term anticoagulation as treatment for Budd-Chiari syndrome
D A Campbell1, K Rolles, N Jamieson
1Department of Surgery, Addenbrooke's Hospital, Cambridge.
Insights
Hepatic transplantation can be successful for Budd-Chiari syndrome when combined with early anticoagulant therapy. This approach significantly reduces hepatic vein thrombosis and improves patient survival rates.
Area of Science:
- Hepatology
- Transplantation Surgery
- Vascular Surgery
Background:
- Budd-Chiari syndrome (BCS) management is challenging, with conventional therapies often yielding poor outcomes.
- Hepatic failure in BCS necessitates exploring advanced treatment options like liver transplantation.
Observation:
- This study reports on 19 hepatic transplants performed on 17 patients diagnosed with Budd-Chiari syndrome.
- Initial management without postoperative anticoagulation led to recurrent hepatic vein thrombosis in the transplanted liver.
Findings:
- Implementing early postoperative anticoagulant therapy in 16 patients resulted in 88% survival at one and three years.
- No recurrent hepatic vein thrombosis was observed in patients receiving anticoagulation, with a mean follow-up of 28.2 months.
- Hemorrhagic complications occurred in 44% of anticoagulated patients, but without mortality; thrombotic events unrelated to hepatic veins occurred in 31%.
Implications:
- Hepatic transplantation, coupled with early and long-term anticoagulation, offers a viable solution for carefully selected BCS patients with hepatic failure.
- Careful patient selection and management of anticoagulation-related complications are crucial for optimizing outcomes in BCS liver transplantation.
Abstract:
Conventional medical and surgical management of Budd-Chiari syndrome is often unsuccessful. In this communication, we report the results of 19 hepatic transplants done for 17 patients suffering from Budd-Chiari syndrome. The first patient who had a transplant did not receive anticoagulant therapy during the postoperative period, and recurrent thrombosis of the hepatic veins in the newly transplanted liver rapidly developed. Sixteen patients who subsequently underwent transplantation were managed using a philosophy of early postoperative anticoagulant treatment when feasible. Using this approach, the cumulative proportion of patients surviving at one and three years was 88 per cent, and no recurrent hepatic vein thrombosis occurred during a mean follow-up period of 28.2 months. Forty-four per cent of the patients who were deliberately given anticoagulant medication experienced a hemorrhagic complication in the postoperative period, but there were no associated deaths. In spite of anticoagulant therapy, 31 per cent of the patients on anticoagulantion medication experienced a thrombotic complication that did not involve the hepatic veins; one early and one late death resulted, and a third patient required urgent retransplantation. Despite the difficulties in patient management, a carefully selected population of patients with hepatic failure secondary to Budd-Chiari syndrome appear to be well served by hepatic transplantation with early postoperative and long term anticoagulant therapy.