title: Long-term follow-up of liver transplantation for Budd-Chiari syndrome with antithrombotic therapy based on the etiology.
abstract: BACKGROUND
  Because myeloproliferative disorders (MPDs) are a frequent cause of Budd-Chiari syndrome (BCS), treatment directed toward altering platelet production and function may be more rational and effective than anticoagulation after liver transplantation.
  
  
  METHODS
  We reviewed data on 25 patients who received liver transplantation for BCS at our institution from 1987 to 2007. Posttransplant antithrombotic treatment was based on the cause of BCS: 17 patients with MPDs received hydroxyurea/aspirin; 5 received warfarin; and 3 (2 whose hypercoagulable disorder was corrected and 1 with sarcoidosis) received no therapy.
  
  
  RESULTS
  Both graft survival (88% at 5 years) and patient survival (92% at 5 years) were superior in the BCS group compared with the 2609 patients who received liver transplants for other indications. Vascular complications included three instances of hepatic artery stenosis (NS compared with non-BCS liver recipients), one of portal vein thrombosis (nonsignificant [NS]), and one of portal vein stenosis (NS). All 25 patients underwent multiple liver biopsies with no bleeding complications.
  
  
  CONCLUSIONS
  Using hydroxyurea and aspirin to treat patients with BCS caused by an MPD seems to be safe and effective and avoids the risks of anticoagulation with warfarin.
authors.affiliation: Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75246, USA.
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Peter
authors.initials: P
authors.lastname: Kim
authors.forename: Koji
authors.initials: K
authors.lastname: Tomiyama
authors.forename: Erik
authors.initials: E
authors.lastname: Klintmalm
authors.forename: Gary L
authors.initials: GL
authors.lastname: Davis
authors.forename: James F
authors.initials: JF
authors.lastname: Trotter
authors.forename: Rana
authors.initials: R
authors.lastname: Saad
authors.forename: Carmen
authors.initials: C
authors.lastname: Landaverde
authors.forename: Marlon F
authors.initials: MF
authors.lastname: Levy
authors.forename: Robert M
authors.initials: RM
authors.lastname: Goldstein
authors.forename: Marvin J
authors.initials: MJ
authors.lastname: Stone
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D006502:Budd-Chiari Syndrome / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D002648:Child; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011169:Portal Vein; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013927:Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin; D006918:Hydroxyurea