Single-Center Experience of Living-Donor Liver Transplantation for Budd-Chiari Syndrome: A Retrospective Cohort Study

Abstract

IntroductionLiving-donor liver transplantation (LDLT) for Budd-Chiari syndrome (BCS) poses unique technical and management challenges. The LDLT outcomes for BCS compared to other indications are not clear and warrant further elucidation.MethodsData from twenty-six BCS (20 adults and 6 children) who underwent LDLT between January 2019 and June 2023 were retrospectively analyzed to report the outcomes. In addition, adult BCS recipients (n = 20) were compared for perioperative parameters and outcomes with a matched control group consisting of recipients (n=50) transplanted for other indications.ResultsThe median age of the adult BCS recipients was 25 years, while that of the pediatric patients was 11 years. The majority (84.62%) of the BCS recipients were male, and all (100%) had a primary form. Ascites was the most common (73.07%) symptom. Only five patients (19.23%) underwent radiological intervention before transplantation. Retrohepatic caval replacement was performed in five patients (19.23%). Clavien-Dindo major morbidity (grade 3b/4) was documented in eight (30.76%). Hepatic arterial thrombosis and venous outflow obstruction were documented in three (11.53%) patients each. Compared with the control group, BCS recipients experienced prolonged cold ischemia and operative time, heightened blood loss, and a greater need for transfusions, as well as a longer hospital stay and higher incidence of outflow obstruction (p <0.05).  The BCS cohort had one-year and 3-years survival of 84.6% and 73.1%, respectively, compared to 90% and 82% in the non-BCS group, respectively (log-rank, p= 1.08).ConclusionAlthough BCS patients are technically difficult, they can have comparable outcomes to non-BCS recipients with a good operative strategy, optimal postoperative anticoagulation, and regular surveillance for outflow complications.

Note:
Funding Information: The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Interests: The authors declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article

Ethics Approval Statement: Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Institutional Ethics Committee (GIMS/IRB/23/3). Informed consent was obtained from the patient’s parents for participation.

Keywords: Budd Chiari syndrome, living donor, Liver transplantation, Outcome, Caval replacement