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Cirrhosis etiology was Budd-Chiari syndrome (BCS) associated with systemic lupus erythematosus, autoimmune hepatitis, and primary biliary cholangitis overlap syndrome. Extensive pre-vertebral collateral veins permitted excision of the obstructed retrohepatic IVC and an alternative suprahepatic IVC-to-right atrium anastomosis without infrahepatic reconstruction. Despite restored venous patency and normalized graft function, cecum perforation and cardiovascular/respiratory insufficiency developed, causing death two months post-transplant. The report argues for individualized surgical planning and reviews adult cases of IVC-atrial anastomosis.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/inferior-vena-cava-atrial-anastomosis-in-liver-transplant-recipient-with-inferior-vena-cava-occlusion-a-case-report-and-literature-review/461455/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/inferior-vena-cava-atrial-anastomosis-in-liver-transplant-recipient-with-inferior-vena-cava-occlusion-a-case-report-and-literature-review/461455.png","ImageObject",300,407,{"name":92,"@type":93},"Danger Angel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What patient condition prompted the liver transplantation attempt?","Question",{"text":112,"@type":113},"A 25-year-old woman had decompensated liver cirrhosis with complete inferior vena cava occlusion, attributed to Budd-Chiari syndrome related to systemic lupus erythematosus and an AIH-PBC overlap syndrome.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What surgical approach was used to restore venous outflow during transplantation?",{"text":117,"@type":113},"The team excised the obstructed retrohepatic IVC and performed an alternative anastomosis between the suprahepatic IVC and the right atrium without reconstructing the infrahepatic IVC, enabled by extensive collateral pre-vertebral veins.",{"name":119,"@type":110,"acceptedAnswer":120},"What outcomes occurred after surgery?",{"text":121,"@type":113},"Venous patency was good and liver graft function normalized, but the patient later developed cecum perforation and cardiovascular and respiratory insufficiency, resulting in death two months after transplantation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461455,1790790102,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090769052,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Case Report  \nInferior Vena Cava-Atrial Anastomosis in Liver Transplant Recipient with Inferior Vena Cava Occlusion: A Case Report and Literature Review  \nJakub Rocho ´n 1, Piotr Kalinowski 1, *, Joanna Marczak 1, Krzysztof Gibi ´nski 2 and Michał Gra˛t 1  \n1 Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1a st., 02-097 Warsaw, Poland; [kuba.rochon@gmail.com](kuba.rochon@gmail.com) (J.R.); [joasia.marczak5@gmail.com](joasia.marczak5@gmail.com) (J.M.); [michal.grat@wum.edu.pl](michal.grat@wum.edu.pl) (M.G.)  \n2 II Department of Clinical Radiology, Medical University of Warsaw, 02-097 Warsaw, Poland; [krzysztof.gibinski@uckwum.pl](krzysztof.gibinski@uckwum.pl)  \n* [Correspondence: piotr.kalinowski@wum.edu.pl](Correspondence: piotr.kalinowski@wum.edu.pl)  \nAbstract  \nA 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.  \nKeywords: inferior vena cava thrombosis; liver transplantation; autoimmune hepatitis; primary biliary cholangitis; Budd-Chiari syndrome; surgical technique  \nAcademic Editor: Pierluigi Toniutto  \nReceived: 10 December 2025  \nRevised: 31 December 2025  \nAccepted: 2 January 2026  \nPublished: 5 January 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1. Introduction  \nInferior vena cava (IVC) obstruction is a rare entity in liver transplant candidates, but it may be a limiting factor for transplantation in the most severe cases. Extensive obstruction of the IVC restricts the use of routine surgical techniques and may constitute a contraindication to liver transplantation (LTx) . Current guidelines do not address the management of a complete IVC obstruction [1] . LTx with anatomical reconstruction of the hepatic vasculature may be technically infeasible in such cases. Therefore, non-standard surgical approaches should be considered in liver transplant recipients.  \nIn patients with end-stage liver disease, coagulopathy is often observed, and comorbidities may contribute to hypercoagulability. In rare cases, patients with systemic lupus  \nerythematosus (SLE) may present with Budd-Chiari syndrome (BCS) as a manifestation of lupus-related antiphospholipid syndrome (APS), leading to large venous thrombosis. The presence of APS has been reported in 10–12% of cases of BCS [2] . Furthermore, the autoimmune hepatitis and primary biliary cholangitis (AIH-PBC) overlap syndrome has been reported with an incidence of approximately 2% in SLE patien","cbCaimvFmDnsKjEX","https://ap.wps.com/l/cbCaimvFmDnsKjEX","pdf",719998,"English","# Abstract\n# Introduction\n## Vascular obstruction and surgical constraints\n## Etiology: lupus, Budd-Chiari, and AIH-PBC overlap\n## Management options: anticoagulation, thrombolysis, thrombectomy\n## Surgical strategies for incomplete and complete IVC occlusion\n# Case Presentation","[{\"question\":\"What patient condition prompted the liver transplantation attempt?\",\"answer\":\"A 25-year-old woman had decompensated liver cirrhosis with complete inferior vena cava occlusion, attributed to Budd-Chiari syndrome related to systemic lupus erythematosus and an AIH-PBC overlap syndrome.\"},{\"question\":\"What surgical approach was used to restore venous outflow during transplantation?\",\"answer\":\"The team excised the obstructed retrohepatic IVC and performed an alternative anastomosis between the suprahepatic IVC and the right atrium without reconstructing the infrahepatic IVC, enabled by extensive collateral pre-vertebral veins.\"},{\"question\":\"What outcomes occurred after surgery?\",\"answer\":\"Venous patency was good and liver graft function normalized, but the patient later developed cecum perforation and cardiovascular and respiratory insufficiency, resulting in death two months after transplantation.\"}]","Inferior Vena Cava-Atrial Anastomosis in Liver Transplant Recipient with Inferior Vena Cava Occlusion - A Case Report and Literature Review | PDF",1790761660,25]