Treacherous Pitfalls in Liver Transplantation for Budd-Chiari Syndrome: When the Devil Hides in the Shadows-A Case Report.
Isabela Couto Mendonça, Daniel Reis Waisberg, Maciana Santos Silva et al.
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Case in brief
A 33-year-old male with Budd-Chiari syndrome underwent liver transplantation using the piggyback technique. Intraoperatively, a fibrotic and narrowed retrohepatic inferior vena cava (IVC) was identified, leading to a side-to-side cavocaval anastomosis. Despite initial graft perfusion, the patient developed primary graft nonfunction due to severe venous outflow obstruction from unrecognized stenosis of the native suprahepatic IVC, necessitating urgent retransplantation, which was successful.
What made this case unusual
The case highlights the challenge of unrecognized suprahepatic IVC stenosis, which led to acute post-transplant hepatic venous outflow obstruction, a complication not commonly anticipated in liver transplantation for Budd-Chiari syndrome.
Diagnostic / clinical pearl
Clinicians should be vigilant for subtle anatomical anomalies, such as suprahepatic IVC stenosis, in patients with Budd-Chiari syndrome undergoing liver transplantation, as these can lead to significant postoperative complications.
Why it matters
Understanding the potential for anatomical variations in Budd-Chiari syndrome is essential for improving surgical outcomes and minimizing the risk of graft failure during liver transplantation.