title: Living donor liver transplantation for Budd-Chiari syndrome with hepatic inferior vena cava obstruction after open pericardial procedures.
abstract: Living donor liver transplantation (LDLT) for Budd-Chiari syndrome (BCS) presents a unique challenge as it does not involve replacement of the hepatic inferior vena cava (IVC). We report a case of successful LDLT in a patient with BCS associated with occlusion of the hepatic veins as well as the IVC. A 34-year-old woman with a history of two open pericardial procedures had decompensated liver failure and portal hypertension. Venography showed complete obstruction of the hepatic IVC and well-developed collateral vessels. We performed LDLT via sternotomy and laparotomy, with an end-to-end anastomosis between the left hepatic vein of the donor and the patient's suprahepatic vena cava in the pericardium. The patient recovered uneventfully and has been doing well for 5 years. LDLT without caval replacement for BCS in a patient with hepatic IVC obstruction is feasible if the patient has good functional collaterals before liver transplantation.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Hospital, Kyoto, Japan, fukuda-a@ncchd.go.jp.
authors.forename: Akinari
authors.initials: A
authors.lastname: Fukuda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Akira
authors.initials: A
authors.lastname: Mori
authors.forename: Michiya
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D006502:Budd-Chiari Syndrome / Q000601:surgery*; D005260:Female; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D010496:Pericardium / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior / Q000601:surgery*