Abstract

Introduction and Background: Living donor Liver Transplantation (LDLT) is indicated in decompensated cirrhosis with Budd-Chiari syndrome (BCS) when a cadaveric organ is unavailable. The procedure involves complex reconstruction, sometimes requiring veno-veno bypass (VVB) because of prolonged time for replacement of Inferior Vena Cava (IVC). Veno-veno bypass has its own complication. At the same time caval clamping alone to avoid bypass is feared to cause renal impairment. So, we did the following cases without the need of bypass in a specific way.

Summary of Cases: We present two cases of primary BCS with IVC involvement who underwent LDLT with the need of veno veno bypass with prosthetic graft replacement. A 21 year old male was having thrombosis of HV and a segment of infradiaphragmatic IVC and features of decompensated CLD. A right lobe liver graft with reconstructed MHV (PTFE - used for draining segment 5 and 8) was prepared. Additionally, back bench implantation of the RHV and neo MHV was done into a Dacron graft (the IVC replacement used in this case instead of cadaver graft). Thrombosed segment of IVC was removed and reconstruction of the implant was done in a standard fashion. Second case was a 48 year old male with thrombosed HV and a segment of IVC with features of decompensated CLD. He also underwent LDLT in a similar fashion.

Discussion and Conclusion: Living donor liver transplant with Caval reconstruction using a Dacron graft is a viable option for decompensated cirrhosis secondary to BCS. Ex-vivo reconstruction is quicker and shortens caval clamping time. Short duration caval clamping will not necessarily lead to postoperative renal impairment provided hemodynamic stability is maintained during the period on clamp.

Keywords: Living donor Liver Transplantation (LDLT); Budd-Chiari syndrome (BCS); Inferior Vena Cava (IVC)

References

1. Ara C., et al. “Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation”. Halldorson Medicine43 (2016): e5136.
2. Sabra TA., et al. “Living donor liver transplantation for adult Budd Chiari syndrome - Resection without replacement of retrohepatic IVC: A case report”. International Journal of Surgery Case Reports 42 (2018): 50-54.
3. Pahari H., et al. “Hepatic Venous and Inferior Vena Cava Morphology No Longer a Barrier to Living Donor Liver Transplantation for Budd-Chiari Syndrome: Surgical Techniques and Outcomes”. Transplantation Proceedings 8 (2016): 2732-2737.
4. Yaylak F., et al. “Living Related Donor Liver Transplantation with Atrio-Caval Anastomosis of Inferior Vena Cava Graft Stored in Deep-Freeze for Budd-Chiari Syndrome”. International Journal of Organ Transplantation Medicine1 (2015): 41-43.

Citation

Citation: Soundappan S., et al. “Ex-Vivo Reconstruction of Right Lobe Liver Graft with a Dacron Caval Interposition Graft for Budd-Chiari Syndrome without Veno-Veno Bypass". Acta Scientific Clinical Case Reports 1.10 (2020): 09-12.

Copyright

Copyright: © 2020 Soundappan S., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.