Living donor liver transplantation for Budd–Chiari syndrome

Abstract

Background:The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS).Methods:Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n = 4) or aortic graft (n = 2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft.Results:Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence.Conclusion:Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools.

Living-donor liver transplantation in Budd-Chiari syndrome with inferior vena cava complete thrombosis: A case report and review of the literature

“…Novel alternative techniques, aimed at eliminating stenosis or obstruction in the recipient IVC, are thus needed for LDLT in the context of BCS[ 6 ]. Some of them include cross-clamping the supra- and infrahepatic IVC and excising its thickened wall to create a wide orifice for graft implantation[ 7 ] or the V-Y plasty technique[ 12 ].…”

“…In 2006, Yan et al [ 14 ] reported the first LDLT for BCS with IVC reconstruction using an interposed cryopreserved cadaveric IVC graft[ 14 ]. Since then, many other studies have addressed IVC reconstruction with interposing autologous veins[ 15 ], cadaveric venous allografts[ 3 , 7 , 16 - 18 ], cadaveric aortic allografts[ 7 , 17 - 20 ], synthetic material[ 12 , 13 , 18 ] or a combination of synthetic material and autologous vein[ 21 , 22 ] or venous allografts[ 18 , 23 ]. Table 2 provides a review of all cases found in the literature of LDLT for BCS with IVC resection.…”

“…The challenge is even greater when considering living donor liver transplantation (LDLT) since the graft does not contain the retrohepatic IVC, as in deceased-donor liver transplantation (DDLT). Therefore, hepatic venous reconstruction is more complex, especially if the IVC is also obliterated[ 7 ]. That is the reason why only approximately 70 patients with BCS underwent LDLT worldwide between 1989 and 2015[ 1 , 8 ].…”

Inferior Vena Cava Constriction After Liver Transplantation Is a Severe Complication Requiring Individually Adapted Treatment: Report of a Single-Center Experience

“…The Korean standardization of right-lobe LDLT suggests preservation of retro-hepatic IVC and unification venoplasty techniques for reconstruction of the inferior right hepatic vein [ 42 ], which was likewise performed in our center. Venous augmentation is frequently performed in highly experienced LDLT centers [ 41 , 43 , 44 ], and PTFE grafts [ 41 , 43 ] or homologous vascular grafts [ 43 , 45 ] can be used. Although remaining a rare complication after LDLT, IVC stenosis can be successfully treated by PTA [ 44 ].…”

Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis

“…152,153 Although the evidence comes from a small series of cases, living donor liver transplant is a viable choice with acceptable survival rates (>70% at 5 years). 154,155 Treatment of recent NCPVT The aim of therapy for recent NCPVT is to prevent the extension of the thrombus to mesenteric veins and intestinal infarction. In addition, therapy for recent NCPVT must try to achieve portal vein recanalization to prevent the development of portal hypertension.…”