The role of communicant veins between hepatic veins in the treatment of Budd-Chiari syndrome with liver transplantation
10.3760/cma.j.issn.0254-1785.2017.09.010
- VernacularTitle:肝静脉交通支在肝移植治疗布加综合征中的作用
- Author:
Shaofa WANG
1
;
Zhishui CHEN
;
Dong CHEN
;
Lai WEI
;
Jipin JIANG
;
Hongchang LUO
;
Kaiyan LI
;
Gen CHEN
;
Hao TANG
Author Information
1. 华中科技大学同济医学院附属同济医院器官移植研究所教育部/卫生部重点实验室
- Keywords:
Budd-Chiari syndrome;
Hepatic veins;
Collateral veins;
Liver transplantation;
Tomography,X-ray computed;
Magnetic resonance imaging
- From:
Chinese Journal of Organ Transplantation
2017;38(9):559-563
- CountryChina
- Language:Chinese
-
Abstract:
Objective Budd-Chiari syndrome is apt to be misdiagnosed,so we explore its diagnosis and treatment by liver transplantation.Methods We retrospectively analyzed the clinical data of two patients who underwent liver transplantation for Budd-Chiari syndrome.One patient was misdiagnosed before the transplantation and another was diagnosed correctly.Results Both patients were grouped to Child C category with decompensated liver cirrhosis.Patient 1 was diagnosed as recurrent hepatocellular carcinoma,but the etiology of liver disease was first unknown then suspected to be schistosomiasis.This patient underwent piggyback liver transplantation.Because there was significant swelling in the perineum and lower extremities after liver transplantation,we re-reviewed the preoperative imaging data and found communicant veins between hepatic veins,which proved that the patient was actually suffered from Budd-Chiari syndrome with hepatic vein and suprahepatic vena cava occlusion before the transplantation.After conservative treatment,the swelling of the lower body was alleviated,however,the long-term survival of the patient would be compromised.Learning from the first case,we found communicant veins between hepatic veins in imaging data of patient 2,resulting in correct diagnosis of Budd-Chiari syndrome with hepatic vein and retrohepatic vena cava diseases before the transplantation,so the patient underwent orthotopic liver transplantation,in which the liver and retrohepatic vena cava were resected,and recovered uneventfully.Liver function was normal during the follow up period of 7 months.Conclusion We should consider the possibility of Budd-Chiari syndrome in patients with unexplained end-stage liver diseases.Communicant veins between the hepatic veins shown in thin CT or MRI image are the characteristic sign for diagnosing Budd-Chiari syndrome.Simultaneously hepatic vein or cava vena disease determines the choice of various technique of liver transplantation.
