Salvage living donor liver transplantation after percutaneous transluminal angioplasty for recurrent Budd-Chiari syndrome: a case report.

Abstract

INTRODUCTION:

Budd-Chiari syndrome is a very rare pathological entity that ultimately leads to liver failure. Several therapeutic modalities, including percutaneous transluminal angioplasty, have been attempted to save the life of patients with Budd-Chiari syndrome. Few reports have described a salvage living donor liver transplantation performed after percutaneous transluminal angioplasty in a patient with acute Budd-Chiari syndrome.

CASE PRESENTATION:

A 26-year-old Japanese man developed severe progressive manifestations, such as massive ascites and hematemesis due to rupture of esophageal varices. After making several investigations, we diagnosed the case as Budd-Chiari syndrome. We first performed percutaneous transluminal angioplasty to dilate a short-segment stenosis of his inferior vena cava. The first percutaneous transluminal angioplasty greatly improved the clinical manifestations. However, after a year, re-stenosis was detected, and a second percutaneous transluminal angioplasty failed to open the severe stricture of his inferior vena cava. Since our patient had manifestations of acute liver failure, we decided to perform salvage living donor liver transplantation from his brother. The transplantation was successfully performed and all clinical manifestations were remarkably alleviated.

CONCLUSION:

In cases of recurrent Budd-Chiari syndrome, the blocked hepatic venous outflow is not always relieved, even with invasive therapies. We have to take into account the possibility of adopting alternative salvage therapies if the first therapeutic modalities fail. When invasive therapy such as percutaneous transluminal angioplasty fails, liver transplantation should be considered as an alternative option.

• Authors: Yusaku Shirai, Hitoshi Yoshiji, Saiho Ko, Masaharu Yamazaki, Yasuhide Ikenaka, Ryuichi Noguchi, Chie Morioka, Kosuke Kaji, Yosuke Aihara, Keisuke Nakanishi, Junichi Yamao, Masahisa Toyohara, Akira Mitoro, Masayoshi Sawai, Motoyuki Yoshida, Masao Fujimoto, Masahito Uemura, Yoshiyuki Nakajima, Hiroshi Fukui
• Journal: Journal of medical case reports (J Med Case Rep) Vol. 5 Pg. 124 (Mar 29 2011) ISSN: 1752-1947 [Electronic] England
• PMID: 21447168 (Publication Type: Journal Article)