Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, Tamil Nadu, India.
Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, Tamil Nadu, India.
World J Surg. 2022 Nov;46(11):2806-2816. doi: 10.1007/s00268-022-06709-4. Epub 2022 Sep 7.
There are unique technical and management challenges associated with living donor liver transplantation (LDLT) for Budd-Chiari Syndrome (BCS). The outcomes of LDLT for BCS in comparison to other indications remain unclear and warrant elucidation.
Data of 24 BCS patients who underwent LDLT between January 2012 and June 2019 were analyzed. There were 20 adults and 4 children. The early and long-term outcomes of adult LDLT BCS patients were compared to a control group of LDLT patients for other indications and matched using propensity scoring methodology.
Primary BCS was observed in 18 (90%) patients. Caval replacement was performed in 7 (35%) patients. Early and late hepatic venous outflow tract (HVOT) complications were seen in 1 (5%) and 3 (15%) patients. Preoperative acute kidney injury was identified as a risk factor for mortality in the BCS cohort (p = 0.013). On comparison, BCS recipients were younger with fewer comorbidities, more large volume ascites and higher rates of PVT. They also had longer cold ischemia time, increased blood loss and transfusion requirements, increased hospital stay, and higher late outflow complications. The 1-year and 3-year survivals were similar to non-BCS cohort (84.2% vs. 94% and 71.3% vs. 91.9%, respectively, log rank test p = 0.09).
LDLT is a good option for symptomatic BCS who have failed non-transplant interventions. The clinical and risk factor profile of BCS recipients is distinct from non-BCS recipients. By following an algorithmic management protocol, we show on propensity-score matched analysis that outcomes of LDLT for BCS are similar to non-BCS indications.
与布加综合征（BCS）相关的活体肝移植（LDLT）存在独特的技术和管理挑战。LDLT 治疗 BCS 的结果与其他适应证相比尚不清楚，需要进一步阐明。
分析了 2012 年 1 月至 2019 年 6 月期间接受 LDLT 的 24 例 BCS 患者的数据。患者包括 20 名成人和 4 名儿童。采用倾向性评分匹配方法，将成人 LDLT 治疗 BCS 患者的早期和长期结果与其他适应证的 LDLT 患者的对照组进行比较。
原发性 BCS 见于 18 例（90%）患者。7 例（35%）患者行腔静脉置换术。1 例（5%）和 3 例（15%）患者出现早期和晚期肝静脉流出道（HVOT）并发症。BCS 组中术前急性肾损伤是死亡的危险因素（p=0.013）。相比之下，BCS 受者年龄较小，合并症较少，大量腹水较多，PVT 发生率较高。他们还具有更长的冷缺血时间、增加的出血量和输血需求、更长的住院时间以及更高的晚期流出并发症。1 年和 3 年的生存率与非 BCS 组相似（分别为 84.2%对 94%和 71.3%对 91.9%，log rank 检验 p=0.09）。
LDLT 是对非移植干预失败的有症状 BCS 的一种较好的选择。BCS 受者的临床和危险因素特征与非 BCS 受者不同。通过遵循算法管理方案，我们在倾向性评分匹配分析中表明，LDLT 治疗 BCS 的结果与非 BCS 适应证相似。
