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Liver transplantation for Budd-Chiari syndrome: A challenging but handable procedure
Hikmet Aktas1, Ali Ozer1, Tonguc Utku Yilmaz1
1Department of Organ Transplantation, Acibadem Mehmet Ali Aydinlar Atakent University Hospital, Istanbul, Turkey.
Insights
Liver transplantation is a viable treatment for Budd-Chiari syndrome (BCS), despite increased thrombotic risks. Personalized strategies ensure comparable outcomes for BCS patients undergoing liver transplants.
Area of Science:
- Hepatology
- Transplantation Surgery
- Vascular Surgery
Background:
- Budd-Chiari syndrome (BCS) poses challenges in liver transplantation, particularly regarding venous outflow reconstruction.
- Patients with BCS often experience complications like vascular thrombosis and biliary issues post-transplant.
Purpose of the Study:
- To evaluate the outcomes of liver transplantation in patients with Budd-Chiari syndrome.
- To compare the results of liver transplantation in BCS patients with those transplanted for other liver diseases.
Main Methods:
- A single-center study analyzed 33 patients with BCS who underwent liver transplantation (27 from living donors).
- Outcomes and surgical features were compared between the BCS group and a control group transplanted for other etiologies.
Main Results:
- Classical BCS was the most common type (75.8%).
- A high prevalence of prothrombotic disorders (78.2%) was noted in the BCS group.
- The BCS group showed a significantly increased risk of thrombotic complications (p=0.014) but had comparable 1 and 3-year survival rates (81.8% and 78.8%) to the control group (93.3% and 88.9%).
Conclusions:
- Liver transplantation is effective for Budd-Chiari syndrome.
- Individualized surgical and postoperative management strategies are key to achieving comparable outcomes in BCS patients.
Backround:
Establishing venous outflow in liver transplantation for patients with Budd-Chiari syndrome is crucial and requires various surgical techniques. The outcomes of these patients exibits distinct problems including vasculary thrombosis and biliary complications.
Methods:
In this single center study, the outcomes and surgical features of 33 patients with Budd-Chiari syndrome who were carried out liver translantation (27 patients from living donor). Another group was formed among patients underwent liver transplantation due to other etiologies and the outcomes were compared.
Results:
The most-seen type was the classical type of Budd-Chiari syndrome (25, 75.8%). For twenty-six patients inherited or acquired prothrombotic disorders were identified (78.2%) in Budd-Chiari group. Average follow-up was 29.7 ± 15.5 months. We have observed no recurrence of disease in our BCS patients. When the two groups was compared in terms of thrombotic complications, there was a significantly increased risk in BCS group (p = 0.014). Our 1 and 3-year survival rates for the BCS group were 81.8% and 78.8%, respectively. In the control group, 1 and 3-year survival rates were 93.3% and 88.9%, respectively. Log-rank test analyses showed no statistically significant results.
Conclusion:
Liver transplantation with individual surgical and postoperative treatment strategy for patients with Budd-Chiari syndrome provides comparable outcomes.
