title: Transdiaphragmatic exposure for direct atrioatrial anastomosis in liver transplantation.
abstract: BACKGROUND
  Liver transplantation in Budd-Chiari syndrome remains controversial; however, some improved techniques lead to better results. We report medium-term follow-up results of liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome and explore the indications of liver transplantation with atrioatrial anastomosis for patients with end stage liver disease.
  
  
  METHODS
  Nine patients (six Budd-Chiari syndromes, one end stage hepatolithiasis, one hepatocellular carcinoma and one incurable alveolar echinococcosis) underwent liver transplantation with atrioatrial anastomosis in West China Hospital of Sichuan University from 1999 to 2006. Eight liver transplants used cadaveric orthotopic livers and one a living donor liver. The operative technique was transdiaphragmatic exposure for direct atrioatrial anastomosis and replacement of inferior vena cava by cryopreserved vena cava graft with the help of venovenous bypass.
  
  
  RESULTS
  All liver transplantations were successful. Two patients contracted pulmonary infection and acute rejection took place in another case. With proper treatment, all patients recovered well and had good quality of life. To date, they have been followed up for more than 24 months. The only death followed recurrence of hepatic carcinoma three years after liver transplantation.
  
  
  CONCLUSIONS
  Transdiaphragmatic exposure for direct atrioatrial anastomosis and the cryopreserved vena cava graft replacement of inferior vena cava are possible for patients with end stage liver disease thus extending the indications of liver transplantation.
authors.affiliation: Division of Liver Transplantation, West China Hospital, West China Medical School of Sichuan University, Chengdu, Sichuan 610041, China.
authors.forename: Zhe-Yu
authors.initials: ZY
authors.lastname: Chen
authors.forename: Lü-Nan
authors.initials: LN
authors.lastname: Yan
authors.forename: Yong
authors.initials: Y
authors.lastname: Zeng
authors.forename: Tian-Fu
authors.initials: TF
authors.lastname: Wen
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: Ji-Chun
authors.initials: JC
authors.lastname: Zhao
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Wang
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.forename: Ming-Qing
authors.initials: MQ
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D006502:Budd-Chiari Syndrome / Q000601:surgery*; D003964:Diaphragm; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior / Q000601:surgery*