Karaca Can A, Yilmaz Cahit, Farajov Rasim, Iakobadze Zaza, Kilic Kamil, Buket Suat, Kilic Murat
From Izmir University of Economics, Faculty of Medicine, Izmir, Turkey.
Exp Clin Transplant. 2025 May;23(5):388-391. doi: 10.6002/ect.2019.0299. Epub 2019 Nov 29.
Living-donor liver transplant for BuddChiari syndrome is particularly challenging because of the need for venous outflow reconstruction as grafts from living donors lack vena cava. In addition, recipient vena cava may be thrombotic and fibrotic to such an extent that it would not allow graft venous outflow reconstruction. Under these circumstances, the right atrium provides an easily accessible alternative for venous outflow reconstruction, omitting the need for vena cava replacement.
Data from 3 patients who were treated using this technique were collected and evaluated with regard to surgical technique and outcomes.
All patients were alive without vascular complications after a mean follow-up of 67 months. The applied surgicaltechnique was similar except with regard to vena cava preservation.
During the natural course of the disease, venous collaterals form as chronic thrombosis extends into the vena cava. The vena cava can be safely resected in these patients to facilitate hepatectomy through dense adhesions, which is another common clinical problem in this disease. Consequently, venous outflow reconstruction to the right atrium creates the feasible opportunity of draining the graftliver without having to replace the vena cava.
由于活体供肝缺乏腔静脉，需要进行静脉流出道重建，因此活体供肝肝移植治疗布加综合征具有特别的挑战性。此外，受体的腔静脉可能存在血栓形成和纤维化，以至于无法进行移植肝静脉流出道重建。在这种情况下，右心房为静脉流出道重建提供了一个易于操作的替代方案，无需进行腔静脉置换。
收集了3例采用该技术治疗的患者的数据，并对手术技术和结果进行了评估。
平均随访67个月后，所有患者均存活，无血管并发症。除腔静脉保留情况外，所应用的手术技术相似。
在疾病的自然发展过程中，随着慢性血栓延伸至腔静脉，静脉侧支循环会形成。在这些患者中，可以安全地切除腔静脉，以利于通过致密粘连进行肝切除术，这是该疾病另一个常见的临床问题。因此，将静脉流出道重建至右心房为引流移植肝创造了可行的机会，而无需置换腔静脉。
