Clinical efficacy of vena cava-atrium anastomosis liver transplantation for Budd-Chiari syndrome

Abstract

Objective To investigate the clinical efficacy of vena cava-atrium anastomosis liver transplantation (VCAALT) for Budd-Chiari syndrome (BCS). Methods The retrospective descriptive study was conducted. The clinicopathological data of 18 BCS patients who underwent VCAALT in the Zhongnan Hospital of Wuhan University (6 cases), the Third Xiangya Hospital of Central South University (8 cases) and Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (4 cases) from May 1996 to December 2012 were collected. All the 18 patients were males, aged from 29 to 61 years, with an average age of 42 years. According to characteristics and invasion extent of hepatic vein and vena cava after preoperative examinations, patients were performed different surgical procedures of VCAALT, including bridge piggyback liver transplantation (BPBLT) , hanging atrium liver transplantation (HALT) and cava vena resection bridge liver transplantation (CVRBLT). Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect patients′ survival up to December 2018. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were described as M (range). Results (1) Surgical and postoperative situations: of 18 patients, 11 underwent BPBLT, 3 underwent HALT, 4 underwent CVRBLT. The operation time and volume of intraoperative blood loss were (6.0±1.3)hours and (1 264±435)mL. One patient died of bilateral pulmonary diffuse inflammation and sepsis due to severe infection. The duration of postoperative hospital stay was (18±5)days. (2) Typical case analysis: one 47-year-old male BCS patient was detected retrohepatic vena cava plaques and thrombus and hepatic venous thrombus by exploratory laparotomy, and underwent BPBLT. A 43-year-old male BCS patient was detected hepatic and retrohepatic vena cava plaques, thrombus, concomitant cavernous transformation, and underwent HALT. A 32-year-old male BCS patient was detected plaques and thrombus with red thrombus in the hepatic vein, from right renal vein to right atrium, and underwent CVRBLT. All the 3 patients underwent VCAALT successfully with a satisfactory recovery. (3) Follow-up situations: 18 patients were followed up for 3.0-60.0 months, with a median time of 51.7 months. During the follow-up, 3 patients died of acute rejection, biliary complications and chronic graft dysfunction at 1, 3, 5 years postoperatively. The 1-, 3-, 5-year survival rates were 16/18, 15/18, 14/18, respectively. Conclusion Different surgical procedures of VCAALT for BCS are selected according to different situations of patients, which are safe and feasible with a satisfactory efficacy and beneficial to long-term survival of patients. Key words: Budd-Chiari syndrome; Liver transplantation; Vena cava-atrium anastomosis; Efficacy