Abstract
ABSTRACT
Unlike deceased‐donor liver transplantation, living‐donor liver transplantation (LDLT) for Budd‐Chiari Syndrome (BCS) presents distinctive challenges in hepatic venous (HV)‐outflow reconstruction because diseased HV–inferior vena cava (IVC) cannot be entirely replaced with healthy donor vessels. In the Asia‐Pacific region, where LDLT predominates, BCS frequently involves the hepatic IVC, thus requiring innovative surgical strategies for HV–IVC reconstruction. Here we introduce a novel series of surgical technique—“intrapericardial approach (IPA)”—which reconstructs HV‐outflow tract in the pericardium using only healthy vascular tissues, thereby minimizing post‐transplant BCS recurrence. Detailed procedures are illustrated for four typical LDLT scenarios, classified by graft‐type (left‐ or right‐lobe) and by the need for IVC reconstruction (acute or chronic BCS). A representative surgical video is also provided. Of our 2089 consecutive liver transplants, 20 patients underwent LDLT for BCS: 10 with conventional IVC‐preserving techniques (cavoplasty and/or patch‐plasty) and 10 using IPA. Across all four clinical scenarios aforementioned, the key concept of IPA—creating new HV‐outflow with only healthy vessels—was consistently applicable. IPA was associated with significantly lower post‐transplant BCS recurrence (
p
= 0.04) and improved both relapse‐free and overall recipient survival (
p
= 0.02 and 0.03, respectively) compared to conventional techniques, yielding 100% graft and patient survival through 10 years. This report also highlights key considerations and pitfalls for pre‐, intra‐, and post‐transplant management in BCS‐LDLT. In conclusion, IPA appears to be associated with reduced post‐transplant BCS recurrence and favorable short‐ and long‐term outcomes, offering a novel practical solution for challenging HV–IVC reconstruction in BCS‐LDLT.