Budd-Chiari Syndrome after Bilateral Nephrectomy for Polycystic Kidney Disease in a Kidney Transplant Recipient

Abstract

We report a rare case of Budd-Chiari syndrome (BCS) as a postoperative complication after bilateral nephrectomy in a kidney transplant recipient with polycystic liver and kidneys. Contrast-enhanced computed tomography of the abdomen showed a narrowed inferior vena cava, compressed by the polycystic liver that moved downwards after nephrectomy. A stenting angioplasty was performed, resulting in remarkable clinical improvement. This case highlights the need for careful evaluation of polycystic kidneys and their anatomic relationship with the liver before nephrectomy, as well as for considering BCS as a differential diagnosis in similar cases.

Unveiling Neglected Concerns: Possible Severe Hepatic Complications after Nephrectomy in Autosomal Dominant Polycystic Kidney Disease – A Case Report

“…Our report shows a patient with ADPKD with splenomegaly, pancytopenia, and an overall worsening of the general condition as complications of hepatic fibrosis raised after bilateral nephrectomy. After mono or bilateral nephrectomy, few incidences of Budd-Chiari syndrome (BCS) or hepatic fibrosis have been documented in patients with ADPKD [ 7 – 9 ]. All patients had significant hepatomegaly but apparently no specific risk factors for BCS or hepatic fibrosis.…”

“…Another possible explanation is that the polycystic liver moves downwards and narrows the inferior vena cava after nephrectomy. In this regard, Foresto et al [ 9 ] reported a case of BCS after bilateral nephrectomy with significant clinical improvement after angioplasty and stenting of the inferior vena cava. While liver cysts in ADPKD patients typically do not impair liver function, nephrectomy seems to increase the risk of liver-related adverse effects.…”