PE-224 : Successful Bypass Operation in Liver Transplant Recipient with Budd-Chiari Syndrome: A Case report

Aims: Budd-Chiari syndrome (BCS) is a rare disease caused by the interruption of hepatic venous drainage in the hepatic vein, inferior vein or right atrium. Resection and replacement of the inferior vena cava (IVC) are standard procedures fro deceased donor liver transplantation (DDLT) for patients with BCS. However, there is no definite method for resolving liver cirrhosis that recur IVC occlusion due to BCS. We report a case of successful bypass surgery in a patient with BCS after liver transplantation (LT). Methods: The patient was a 61-year-old male who underwent DDLT at an outside hospital in 2008 due to liver cirrhosis caused by BCS. At the liver transplant time in an outside hospital, the patient’s condition was so severe that replacement of IVC was not performed. The patient’s condition improved after LT. However, the cirrhosis of the transplanted liver have progressed due to the occlusion of the IVC, which has not been resolved over time. The patient was referred to the our transplantation center for a second opinion. At the time of our first visit, the patient’s condition was not in a state of needing immediate surgical treatment. During outpatient follow-up, patient’s liver function was not bad, but liver cirrhosis were further intensified and decide to perform IVC bypass operation. CT scan shows obliteration of intrahepatic IVC, splenomegaly, increased extent of multiple collateral vessel, and liver cirrhosis due to BCS. Results: The operation time was 415 min and estimated blood loss was 900 ml. The operation was performed under bio-pump applied to lower the pressure. The distal stump was confirmed in the renal vein. We opened the diaphragm to secure the proximal site and clamped the proximal IVC. We used the Dacron 20 mm graft for bypass surgery. After the operation, blood flow through graft was very good. The patient should be on anti-coagulation treatment to prevent obstruction of graft. Conclusions: Bypass surgery using an artificial graft can be a safe and good treatment option in patients with cirrhosis caused by IVC occlusion after LT.