Pandey Yuktansh, Vijayashanker Aarathi, Chikkala Bhargava R, Acharya M Rajgopal, Bashir Shahnawaz, Dey Rajesh, Agarwal Shaleen, Gupta Subhash
From the Centre for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India.
Exp Clin Transplant. 2021 Aug;19(8):799-805. doi: 10.6002/ect.2020.0541. Epub 2021 May 6.
Adequate venous outflow is one of the most important factors responsible for optimal graft function in liver transplantation. Thrombosis of the inferior vena cava in cases of Budd-Chiari syndrome poses a major challenge to a transplant surgeon in establishing proper graft outflow. In deceased donor liver transplant, this problem can be dealt with relative ease as the liver graft includes donor inferior vena cava. However, this is not the case in living donor liver transplant. We present our findings of living donor liver transplant for Budd-Chiari syndrome and discuss techniques that have helped overcome this unique problem without the need for complete inferior vena cava replacement.
Our retrospective analysis included living donor liver transplant recipients from November 2006 to March 2020 at our center and selected patients who underwent this transplant for Budd-Chiari syndrome. We studied the extent and severity of inferior vena cava involvement in these cases. We developed a classification that not only helped to stratify patterns of venacaval disease but also helped to plan the surgical technique. The role of interventional radiology combined with surgery in management of extensive inferior vena cava stenosis was studied.
Among 2952 cases of liver transplant in our unit from November 2006 to March 2020, 36 patients had Budd-Chiari syndrome; 21 had significant level of inferior vena cava thrombosis, which was managed with inferior vena cava thrombectomy with either patchplasty (n = 20) or segmental replacement (n = 1). None of our patients showed recurrence of primary disease during the median follow-up of 36 months (range, 8-158 mo).
Establishment of adequate venous ouflow in thrombosed inferior vena cava is possible with proper planning of surgical technique and timely involvement of interventional radiology-guided interventions in patients with Budd-Chiari syndrome.
充足的静脉流出道是肝移植中移植物功能最佳的最重要因素之一。布加综合征患者的下腔静脉血栓形成给移植外科医生建立合适的移植物流出道带来了重大挑战。在尸体供肝肝移植中，由于肝移植物包含供体下腔静脉，这个问题相对容易解决。然而，在活体供肝肝移植中情况并非如此。我们展示了我们对布加综合征进行活体供肝肝移植的研究结果，并讨论了有助于克服这一独特问题而无需完全置换下腔静脉的技术。
我们的回顾性分析纳入了2006年11月至2020年3月在我们中心接受活体供肝肝移植的患者，并选择了因布加综合征接受该移植的患者。我们研究了这些病例中下腔静脉受累的程度和严重程度。我们制定了一种分类方法，不仅有助于对腔静脉疾病模式进行分层，还有助于规划手术技术。研究了介入放射学联合手术在广泛下腔静脉狭窄管理中的作用。
在我们单位2006年11月至2020年3月的2952例肝移植病例中，36例患有布加综合征；21例有严重的下腔静脉血栓形成，通过下腔静脉血栓切除术加补片成形术（n = 20）或节段置换（n = 1）进行处理。在中位随访36个月（范围8 - 158个月）期间，我们的患者均未出现原发性疾病复发。
通过适当规划手术技术并及时对布加综合征患者进行介入放射学引导的干预，在血栓形成的下腔静脉中建立充足的静脉流出道是可行的。
