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Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation

BACKGROUND: The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS). METHODS: Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively revie...

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Autores principales: Ara, Cengiz, Akbulut, Sami, Ince, Volkan, Karakas, Serdar, Baskiran, Adil, Yilmaz, Sezai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089097/
https://www.ncbi.nlm.nih.gov/pubmed/27787368
http://dx.doi.org/10.1097/MD.0000000000005136
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author Ara, Cengiz
Akbulut, Sami
Ince, Volkan
Karakas, Serdar
Baskiran, Adil
Yilmaz, Sezai
author_facet Ara, Cengiz
Akbulut, Sami
Ince, Volkan
Karakas, Serdar
Baskiran, Adil
Yilmaz, Sezai
author_sort Ara, Cengiz
collection PubMed
description BACKGROUND: The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS). METHODS: Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n = 4) or aortic graft (n = 2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft. RESULTS: Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence. CONCLUSION: Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools.
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spelling pubmed-50890972016-11-07 Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation Ara, Cengiz Akbulut, Sami Ince, Volkan Karakas, Serdar Baskiran, Adil Yilmaz, Sezai Medicine (Baltimore) 7100 BACKGROUND: The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS). METHODS: Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n = 4) or aortic graft (n = 2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft. RESULTS: Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence. CONCLUSION: Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools. Wolters Kluwer Health 2016-10-28 /pmc/articles/PMC5089097/ /pubmed/27787368 http://dx.doi.org/10.1097/MD.0000000000005136 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-sa/4.0 This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0
spellingShingle 7100
Ara, Cengiz
Akbulut, Sami
Ince, Volkan
Karakas, Serdar
Baskiran, Adil
Yilmaz, Sezai
Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation
title Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation
title_full Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation
title_fullStr Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation
title_full_unstemmed Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation
title_short Living donor liver transplantation for Budd–Chiari syndrome: Overcoming a troublesome situation
title_sort living donor liver transplantation for budd–chiari syndrome: overcoming a troublesome situation
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089097/
https://www.ncbi.nlm.nih.gov/pubmed/27787368
http://dx.doi.org/10.1097/MD.0000000000005136
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