Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Living Donor Liver Transplantation for Budd-Chiari Syndrome: A Propensity Score-Matched Analysis

Version 1 : Received: 29 September 2021 / Approved: 1 October 2021 / Online: 1 October 2021 (11:52:48 CEST)

How to cite: Gunasekaran, V.; Reddy, M.S.; Rammohan, A.; Shanmugam, N.P.; Thirchunapalli, D.; Kanagavelu, R.G.; Kaliamoorthy, I.; Rela, M. Living Donor Liver Transplantation for Budd-Chiari Syndrome: A Propensity Score-Matched Analysis. Preprints 2021, 2021100012 (doi: 10.20944/preprints202110.0012.v1). Gunasekaran, V.; Reddy, M.S.; Rammohan, A.; Shanmugam, N.P.; Thirchunapalli, D.; Kanagavelu, R.G.; Kaliamoorthy, I.; Rela, M. Living Donor Liver Transplantation for Budd-Chiari Syndrome: A Propensity Score-Matched Analysis. Preprints 2021, 2021100012 (doi: 10.20944/preprints202110.0012.v1).

Abstract

Introduction: There are unique technical and management challenges associated with living donor liver transplantation (LDLT) for Budd-Chiari Syndrome (BCS). The outcomes of LDLT for BCS in comparison to other indications remains unclear and warrants elucidation. Methods: Data of 24 BCS patients who underwent LDLT between January 2012 and June 2019 were analyzed. There were 20 adults and 4 children. The early and long-term outcomes of adult LDLT BCS patients were compared to a control group of LDLT patients for other indications and matched using propensity scoring methodology. Results: Primary BCS was observed in 22(91.7%) patients. Caval replacement was performed in 7(29.1%) patients. Early and late hepatic venous outflow tract (HVOT) complications were seen in 1(5.5%) and 3(16.7%) patients. Preoperative acute kidney injury was identified as a risk factor for mortality in the BCS cohort (p =0.013). On comparison, BCS recipients were younger with fewer comorbidities, more large volume ascites and higher rates of PVT. They also had longer cold ischemia time, increased blood loss and transfusion requirements, increased hospital stay, and higher late outflow complications. The 1-year and 3-year survivals were similar to non-BCS cohort (84.2% vs 94% and 70% vs 91.9%, respectively, log rank test p=0.09). Conclusion: LDLT is remains a good option for symptomatic BCS who have failed non-transplant interventions. The clinical and risk factor profile of BCS recipients is distinct from non-BCS recipients. By following an algorithmic management protocol, we show on propensity-score matched analysis that outcomes of LDLT for BCS are similar to non-BCS indications.

Keywords

Budd-Chiari syndrome; Living donor; Liver transplantation; Propensity score-Matched Analysis; Outcomes

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