# Inferior Vena Cava-Atrial Anastomosis in Liver Transplant Recipient with Inferior Vena Cava Occlusion: A Case Report and Literature Review

## TL;DR

A 25-year-old woman with liver cirrhosis and a blocked inferior vena cava underwent liver transplantation using a novel surgical technique, but she passed away due to complications.

## Contribution

This is the first reported case of liver transplantation using IVC-atrial anastomosis in a patient with AIH-PBC overlap syndrome and lupus-related BCS.

## Key findings

- Liver transplantation was feasible despite complete IVC occlusion due to extensive collateral venous circulation.
- The patient developed post-transplant complications including cecum perforation and cardiovascular insufficiency.
- The case highlights the need for individualized approaches in complex liver transplant scenarios.

## Abstract

A 25-year-old woman with decompensated liver cirrhosis and complete inferior vena cava (IVC) occlusion was referred to our department for liver transplantation. The etiology of cirrhosis was Budd-Chiari syndrome (BCS) related to systemic lupus erythematosus, autoimmune hepatitis, and primary biliary cholangitis (AIH-PBC) overlap syndrome. Transplantation was feasible due to an extensive collateral circulation of pre-vertebral veins that drained blood from the lower extremities and both kidneys to the azygos-hemiazygos veins. This venous anomaly enabled the excision of the obstructed retrohepatic IVC, followed by an alternative anastomosis of the suprahepatic IVC to the right atrium without reconstruction of the infrahepatic IVC. Despite good venous patency and normalization of liver graft function, the patient developed cecum perforation, cardiovascular and respiratory insufficiency, which led to the patient’s death two months after transplantation. This case report supports an individual approach and highlights the feasibility of liver transplantation despite an extensive IVC thrombosis. To our knowledge, it is the first description of the application of a deceased donor liver transplantation in patients with AIH-PBC overlap syndrome and lupus-related BCS. A concise review of published literature on IVC-atrial anastomosis in adult liver transplant recipients is provided, and the technique is discussed based on our recent experience.