title: Hepatic Venous and Inferior Vena Cava Morphology No Longer a Barrier to Living Donor Liver Transplantation for Budd-Chiari Syndrome: Surgical Techniques and Outcomes.
abstract: BACKGROUND
  Living donor liver transplantation (LDLT) for Budd-Chiari syndrome (BCS) has been reported with <10 inferior vena cava (IVC) replacements with vascular/synthetic graft. The goal of this study was to review outcomes of LDLT for BCS at our center, with an emphasis on surgical techniques and postoperative anticoagulation therapy.
  
  
  METHODS
  Between October 2011 and December 2015, a total of 1027 LDLTs were performed. Nine of these patients had BCS. We analyzed their etiologies, operative details, postoperative complications, and outcomes.
  
  
  RESULTS
  The indication was chronic liver disease for all patients. Two patients required retrohepatic IVC replacement with a polytetrafluoroethylene graft due to severe adhesions and thrombosis, respectively. One patient required V-Y plasty for suprahepatic IVC narrowing. Five patients had portal venous thrombosis, 3 treated by thrombectomy, and 1 by renoportal anastomosis. The mean follow-up time was 18 ± 16 months. Only 1 early death occurred due to sepsis. The anticoagulation therapy involved heparin infusion from postoperative day 1, conversion to low-molecular-weight-heparin on postoperative days 3 to 6, followed by warfarin (postoperative days 9-16 to maintain an international normalized ratio of 2-3 long term), along with low-dose aspirin for 6 months. There was no recurrence of thrombosis.
  
  
  CONCLUSIONS
  LDLT for BCS is well documented in literature. Prevention of recurrent thrombosis depends on meticulous surgical technique, perfect and wide outflow anastomoses, and a strict anticoagulation protocol. A synthetic (polytetrafluoroethylene) graft for IVC interposition is a safe and feasible option for reconstruction with good results. Low-dose aspirin with low-molecular-weight-heparin later converted to warfarin provides excellent results and prevents recurrence of thrombosis.
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India. Electronic address: hirak.pahari@gmail.com.
authors: H
authors: H
authors: Pahari
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India.
authors: R J
authors: RJ
authors: Chaudhary
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India.
authors: S
authors: S
authors: Thiagarajan
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India.
authors: V
authors: V
authors: Raut
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India.
authors: R
authors: R
authors: Babu
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India.
authors: P
authors: P
authors: Bhangui
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India.
authors: S
authors: S
authors: Goja
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India.
authors: A
authors: A
authors: Rastogi
authors: Department of Liver Transplant, GI Anaesthesia and Intensive Care, Medanta The Medicity, Gurgaon, India.
authors: V
authors: V
authors: Vohra
authors: Medanta Liver Institute, Medanta The Medicity, Gurgaon, India.
authors: A S
authors: AS
authors: Soin
mesh_terms: D000328:Adult; D006502:Budd-Chiari Syndrome / Q000601:surgery*; D005260:Female; D006503:Hepatic Veins / Q000473:pathology* / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery