The Spectrum of Portal Vein Thrombosis in Liver Transplantation (original) (raw)
Related papers
2011
Portal vein thrombosis (PVT) was for a long time considered a barrier to liver transplantation. The aim of this study is to demonstrate the surgical technical options for portal vein reconstruction during liver transplantation in patients with PVT in which thrombectomy was not possible. Between September 1991 and March 2009, 420 liver transplanted patients were retrospectively analyzed, identifying 29 cases with PVT (6.9%). Preoperative diagnosis, preoperative risk factors, surgical technique options to treat various forms (grades) of PVT, postoperative recurrence and actuarial survival rates were studied. In three cases of PVT grade II and in one case PVT grade III the thrombectomy was insufficient, requiring some surgical technique options (13.79%). In two cases placement of iliac vein graft was performed, in one an anastomosis of the portal vein with collateral splenorenal vein and in the other with left gastric varicose. The actuarial survival rate for patients without PVT and patients with PVT and effective thrombectomy was 73.8% while those with PVT who needed some type of surgical option was 75%. Our results suggest that actuarial survival rates were similar among patients with PVT or PVT with effective thrombectomy when compared with PVT that required some surgical options.
Liver transplantation in the presence of portal vein thrombosis: report from a single center
Transplantation Proceedings, 2004
Portal vein thrombosis (PVT) is a frequent finding in liver transplantation, the management of which depends mainly on its extent. In cases of mild to moderate PVT, a low dissection of the portal trunk, a jump graft, or direct implantation of graft portal vein into large venous collaterals or thrombectomy offer alternatives. For severe PVT anecdotal reports suggest that cavoportal hemitransposition, portal arterialization, or combined liver and intestine transplantation may be attempted, although the results to date are not satisfactory. When extensive perivenous and venous inflammatory changes reach the infrapancreatic region, liver transplantation probably should not be performed due to the high mortality rate.
Transplantation Proceedings, 2005
Introduction. Although portal vein thrombosis (PVT) is no longer considered a contraindication for liver transplantation (OLT), it is still considered a high risk because of the complexity of the surgical procedure. The aim of this study was to evaluate the impact of PVT in the recipient during OLT on intra-and perioperative management and outcome. Patients and Methods. Between April 1986 and October 2003, 721 primary OLT included 64 patients (8.8%) with PVT. The underlying liver disease was postnecrotic cirrhosis in most cases (n ϭ 37). Intraoperative (length of surgery, packed red blood cells (PRBC) transfusion requirements, ischemia time, complications) and postoperative parameters (ICU stay and hospitalization time, complications, actuarial graft and patient survival at 1 month and 1 and 5 years) were compared with a control group of patients submitted to OLT without PVT (n ϭ 657). Results. Portal flow was reestablished in 56 patients with thromboendovenectomy, in seven patients with a venous graft from the superior mesenteric vein, and with cavoportal hemitransposition in one case. The average ICU and hospital stay as well as the 1-month and 1-and 5-year patient survivals were not significantly different in the PVT versus the control group. We observed slightly more PRBC transfusions and longer surgery procedures in the PVT group. Conclusions. Our experience suggests that thromboendovenectomy is the procedure of choice for PVT. The results are good in terms of survival rates and postoperative complications, although the presence of PVT may lead to more technical problems during surgery.
Liver transplantation in the presence of old portal vein thrombosis
International journal of organ transplantation medicine, 2010
Portal vein thrombosis (PVT) has been mentioned as a potential obstacle to liver transplantation (LTx). To review the impact of PVT on orthotopic liver transplant (OLT) outcome. Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 (7.9%) cases had old PVT with recanalization. Data were retrospectively collected regarding the demographics, indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2-2.5. The causes of end-stage liver disease were hepatitis B in 11, cryptoge...
Salvage Procedure for Unexpected Portal Vein Thrombosis in Living Donor Liver Transplantation
Transplantation Proceedings, 2006
Portal vein thrombosis (PVT) is considered a relative contraindication to living donor liver transplantation (LDLTx) due to technical difficulty and ethical considerations. So far, there have been a few reported cases of LDLTx with PVT, most of which were treated by thrombectomy with or without a venous conduit. We report a case of LDLTx in an unexpected recipient with grade 4 diffuse PVT, which was successfully managed using a variceal left gastric vein and a deceased donor iliac vein conduit to create a "de novo portal vein" for splanchnic inflow to the right lobe. The patient experienced an uneventful postoperative course with normal blood flow in the de novo portal vein at 1-year follow up. This report demonstrated that a variceal collateral vein can be used as appropriate alternative inflow for the right lobe in LDLTx cases in which an unexpected PVT is encountered.