Vena Cava-Atrium Anastomosis Liver Transplantation on Patient with Budd-Chiari Syndrome Caused by a Tumor Thrombus in the Inferior Vena Cava: A Case Report

Owing to the difficulty in removing hepatocellular carcinomas associated with extrahepatic metastases and the fact that they may further metastasize along the vessels, liver transplantation is not currently recommended for patients with these conditions. We report a case of Budd-Chiari syndrome (BCS) caused by hepatic carcinoma and tumor thrombus in the inferior vena cava (IVC). Backed by the strong desire of the patient to undergo liver transplantation, we decided to perform vena cava-atrium anastomosis liver transplantation (VCAALT) on the patient after a comprehensive evaluation of the patient’s condition. The patient recovered quickly and was discharged after 1 month of consolidation chemotherapy. BCS caused by an IVC tumor thrombus is a rare clinical case, and selecting an appropriate treatment is difficult. In this case, we successfully solved the clinical problem of BCS in a patient with hepatocellular carcinoma combined with an IVC cancer embolus using VCAALT.
Martens P, Nevens F, 2015, Budd-Chiari Syndrome. United Eur Gastroenterol J, 3:489–500.
Menon KV, Shah V, Kamath PS, 2013, The Budd-Chiari Syndrome. N Engl J Med, 350:578–85.
Meyer BC, Hinrichs JB, Ivanyi P, et al., 2020, Extracorporeal Portosystemic Shunt in Secondary Budd-Chiari Syndrome. J Hepatol, 2020, 73:974–6.
Hidaka M, Eguchi S, 2017, Budd-Chiari Syndrome: Focus on Surgical Treatment. Hepatol Res, 47:142–8.
Qi X, Yang M, Fan D, et al., 2013, Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Budd-Chiari Syndrome: A Critical Review of Literatures. Scand J Gastroenterol, 48:771–84.
Chun YH, Ahn SH, Park JY, et al., 2011, Clinical Characteristics and Treatment Outcomes of Hepatocellular Carcinoma with Inferior Vena Cava/Heart Invasion. Anticancer Res, 31:4641–6.
Jung H, Lee KU, Shin WY, et al., 2011, Treatment Outcomes of Surgical Resection for Hepatocellular Carcinoma with Inferior Vena Cava Invasion and/or Thrombosis. Hepatogastroenterology, 58:1694–9.
Li W, Wang Y, Gao W, et al., 2017, HCC with Tumor Thrombus Entering the Right Atrium and Inferior Vena Cava Treated by Percutaneous Ablation. BMC Surg, 17:21.
Wang Y, Yuan L, Ge RL, et al., 2013, Survival Benefit of Surgical Treatment for Hepatocellular Carcinoma with Inferior Vena Cava/Right Atrium Tumor Thrombus: Results of a Retrospective Cohort Study. Ann Surg Oncol, 20:914–22.
Seijo S, Plessier A, Hoekstra J, et al., 2013, Good Long-term Outcome of Budd-Chiari Syndrome with a Step-wise Management. Hepatology, 57:1962–8.
Liu L, Qi XS, Zhao Y, et al., 2016, Budd-Chiari Syndrome: Current Perspectives and Controversies. Eur Rev Med Pharmacol Sci, 20:3273–81.
Matsukuma S, Eguchi H, Wada H, et al., 2020, Liver Resection with Thrombectomy for Patients with Hepatocellular Carcinoma and Tumour Thrombus in the Inferior Vena Cava or Right Atrium. BJS Open, 4:241–51.
Yoon YI, Lee SG, Moon DB, et al., 2019, Surgical Techniques and Long-term Outcomes of Living-donor Liver Transplantation With Inferior Vena Cava Replacement Using Atriocaval Synthetic Interposition Graft for Budd-Chiari Syndrome. Ann Surg, 269:e43–5.
Mentha G, Giostra E, Majno PE, et al., 2006, Liver Transplantation for Budd-Chiari Syndrome: A European study on 248 patients from 51 centres. J Hepatol, 44:520–8.
Qifa Y, Yingzi M, Nianqiao G, et al., 2019, Clinical Efficacy of Vena Cava-atrium Anastomosis Liver Transplantation for Budd-Chiari Syndrome. Chin J Dig Surg, 18:342–6.