{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:15:27Z","timestamp":1788434127160,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Unlike deceased\u2010donor liver transplantation, living\u2010donor liver transplantation (LDLT) for Budd\u2010Chiari Syndrome (BCS) presents distinctive challenges in hepatic venous (HV)\u2010outflow reconstruction because diseased HV\u2013inferior vena cava (IVC) cannot be entirely replaced with healthy donor vessels. In the Asia\u2010Pacific region, where LDLT predominates, BCS frequently involves the hepatic IVC, thus requiring innovative surgical strategies for HV\u2013IVC reconstruction. Here we introduce a novel series of surgical technique\u2014\u201cintrapericardial approach (IPA)\u201d\u2014which reconstructs HV\u2010outflow tract in the pericardium using only healthy vascular tissues, thereby minimizing post\u2010transplant BCS recurrence. Detailed procedures are illustrated for four typical LDLT scenarios, classified by graft\u2010type (left\u2010 or right\u2010lobe) 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\u2010preserving techniques (cavoplasty and\/or patch\u2010plasty) and 10 using IPA. Across all four clinical scenarios aforementioned, the key concept of IPA\u2014creating new HV\u2010outflow with only healthy vessels\u2014was consistently applicable. IPA was associated with significantly lower post\u2010transplant BCS recurrence (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04) and improved both relapse\u2010free and overall recipient survival (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02 and 0.03, respectively) compared to conventional techniques, yielding 100% graft and patient survival through 10\u2009years. This report also highlights key considerations and pitfalls for pre\u2010, intra\u2010, and post\u2010transplant management in BCS\u2010LDLT. In conclusion, IPA appears to be associated with reduced post\u2010transplant BCS recurrence and favorable short\u2010 and long\u2010term outcomes, offering a novel practical solution for challenging HV\u2013IVC reconstruction in BCS\u2010LDLT.\n                  <\/jats:p>","DOI":"10.1002\/ags3.70205","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:58:35Z","timestamp":1772989115000},"page":"1356-1364","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cIntrapericardial Approach\u201d for Venous Outflow Reconstruction in Living\u2010Donor Liver Transplantation for Budd\u2010Chiari Syndrome: Surgical Techniques and LongTerm Outcomes"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3609-6396","authenticated-orcid":false,"given":"Koichiro","family":"Hata","sequence":"first","affiliation":[{"name":"Department of Surgery, Graduate School of Medicine Kyoto University  Kyoto Japan"},{"name":"Department of Surgery Kyoto City Hospital  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6538-7408","authenticated-orcid":false,"given":"Tetsuya","family":"Tajima","sequence":"additional","affiliation":[{"name":"Department of Surgery, Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9577-330X","authenticated-orcid":false,"given":"Satoshi","family":"Ogiso","sequence":"additional","affiliation":[{"name":"Department of Surgery, Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0126-9346","authenticated-orcid":false,"given":"Shinji","family":"Uemoto","sequence":"additional","affiliation":[{"name":"Department of Surgery, Graduate School of Medicine Kyoto University  Kyoto Japan"},{"name":"Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3407-1918","authenticated-orcid":false,"given":"Etsuro","family":"Hatano","sequence":"additional","affiliation":[{"name":"Department of Surgery, Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2207738"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-021-10189-4"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8278(95)80252-5"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.5582\/irdr.2014.01031"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000005136"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2008.01059.x"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002847"},{"issue":"1","key":"e_1_2_14_9_1","first-page":"41","article-title":"Living Related Donor Liver Transplantation With Atrio\u2010Caval Anastomosis of Inferior Vena Cava Graft Stored in Deep\u2010Freeze for Budd\u2010Chiari Syndrome","volume":"6","author":"Yaylak F.","year":"2015","journal-title":"International Journal of Organ Transplantation Medicine"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14674"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2006.01505.x"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2023.01.039"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002958"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31822c5878"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.1430"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.08.014"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-32-9232-1_14"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(02)00434-8"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-022-06709-4"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3182247b05"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1496-1"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.21037\/hbsn-2025-244"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21354"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.022"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.04.024"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.06.014"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2018.04.009"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021744"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.10.038"}],"container-title":["Annals of Gastroenterological Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70205","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ags3.70205","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70205","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:25:13Z","timestamp":1788431113000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ags3.70205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/ags3.70205"],"URL":"https:\/\/doi.org\/10.1002\/ags3.70205","archive":["Portico"],"relation":{},"ISSN":["2475-0328","2475-0328"],"issn-type":[{"value":"2475-0328","type":"print"},{"value":"2475-0328","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]},"assertion":[{"value":"2025-09-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}