A Case Report: Hanging hepatoatrial anastomosis in cadaveric donor liver transplantation for a Budd-Chiari Syndrome Patient

Abstract

Introduction: The liver transplantations for Budd-Chiari syndrome(BCS) patients are challenging for variety of reasons. There is no standardized procedure for the reconstruction of the diseased hepatic vein or inferior vena cava(IVC) segments. The underlying hypercoagulable state or hematologic disorders in BCS patients may, also, raise problems during postoperative period. Although anastomotic failure of hepatic vein is an unusual complication in adult orthotopic liver transplantation(OLT), pre-existing inferior vena cava abnormality, such as in BCS, may contribute to the increased rate of the hepatic outflow complications. Technical adjustments are to be made in such cases. Method: case: A fifty-one-year-old male patient was admitted to Ajou University Hospital for impending liver failure. He was, previously diagnosed with Budd-Chiari syndrome. The preoperative CT scan revealed extensive IVC trhrombosis from the right atrium inlet to both common iliac veins. Result: A statisfactory result was obtained by hanging hepatoatrial anastomosis during cadaveric donor liver transplantation.. For graft implantation, the upper cuff of the donor IVC was sutured directly to the right atrium and the lower cuff was closed by oversewing. No subsequent complication relevant to this vascular anastomosis was observed during six months of follow-up period. Conclusion: The modification of hepatic outflow reconstruction during liver transplantation that we have named a hanging hepatoatrial anastomosis can be tolerated in such patients with effective collateral vessel system.