Reconstruction of hepatic veins by anastomosis with suprahepatic IVC in the posterior mediastinum in living donor liver transplantation for Budd-Chiari syndrome.

In living donor liver transplantation for Budd-Chiari syndrome, it is necessary to eliminate interference with outflow from the liver without the replacement of the involved retrohepatic segment of the inferior vena cava. A 34-year-old female patient underwent living donor liver transplantation for Budd-Chiari syndrome. During surgery, the fibrous tissue surrounding the recipient inferior vena cava was dissected after removal of the recipient liver. The diaphragm was dissected and mobilized from the inferior vena cava on the cranial side to expose the intact inferior vena cava in the posterior mediastinum. The left and middle hepatic veins in the graft liver were anastomosed to a horizontal anastomotic orifice prepared in the anterior wall of the intact inferior vena cava in the posterior mediastinum. Anticoagulant therapy was begun after liver transplantation. Dynamic computed tomography after living donor liver transplantation demonstrated patent hepatic veins. The patient has been doing well, without any episode of thrombosis or occlusion of the graft hepatic veins at 1 year and 6 months after liver transplantation.