Hepatic Venous Outflow Reconstruction Directly Into the Right Atrium

Abstract

Objectives: Living-donor liver transplant for Budd-Chiari syndrome is particularly challenging because of the need for venous outflow reconstruction as grafts from living donors lack vena cava. In addition, recipient vena cava may be thrombotic and fibrotic to such an extent that it would not allow graft venous outflow reconstruction. Under these circumstances, the right atrium provides an easily accessible alternative for venous outflow reconstruction, omitting the need for vena cava replacement. Materials and Methods: Data from 3 patients who were treated using this technique were collected and evaluated with regard to surgical technique and outcomes. Results: All patients were alive without vascular complications after a mean follow-up of 67 months. The applied surgical technique was similar except with regard to vena cava preservation. Conclusions: During the natural course of the disease, venous collaterals form as chronic thrombosis extends into the vena cava. The vena cava can be safely resected in these patients to facilitate hepatectomy through dense adhesions, which is another common clinical problem in this disease. Consequently, venous outflow reconstruction to the right atrium creates the feasible opportunity of draining the graft liver without having to replace the vena cava.