A selective approach to preexisting portal vein thrombosis in patients undergoing liver transplantation

Langnas, Alan Norman; Marujo, Wagner; Stratta, Robert J.; Wood, Robert; Ranjan, Dinesh; Ozaki, Claire F.; Shaw, Byers W.

doi:10.1016/0002-9610(92)90265-s

Cited by 59 publications

(47 citation statements)

References 4 publications

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“…However, others do not use treatment with heparin. 5,17,19 In our series, the rate of rethrombosis varied with the degree of previous thrombosis (complete PVT, 14.3%; partial PVT, 2%). Two of the 3 cases of rethrombosis appeared in patients with extensive complete PVT in whom thrombectomy was considered incomplete because of the initial inexperience (OLT no.…”

Section: Discussionmentioning

confidence: 55%

Liver transplantation in patients with portal vein thrombosis

Manzanet¹,

Sanjuan²,

Orbis³

et al. 2001

Liver Transpl

167

126

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The aim of this study is to analyze the incidence, risk factors, management, and follow-up of patients with portal vein thrombosis (PVT) undergoing primary orthotopic liver transplantation (OLT). Four hundred fifteen OLTs were performed in 391 patients. In 62 patients, partial (group 1; n ‫؍‬ 48) or complete (group 2; n ‫؍‬ 14) PVT was found at the time of surgery. Portal flow was reestablished by venous thrombectomy. In this study, we compare 62 primary OLTs performed in patients with PVT at the time of OLT with a group of 329 primary OLTs performed in patients without PVT (group 3) and analyze the incidence of PVT, use of diagnostic methods, surgical management, and outcome. We found no significant differences among the 3 groups for length of surgery, cold and warm ischemic times, and postoperative stay in the intensive care unit. With the piggyback technique, groups 1 and 2 had greater blood losses and required more blood transfusions than group 3. The early reoperation rate was greater in group 2. The incidence of rethrombosis was 4.8% (group 1, 2%; group 2, 14.3%). Reexploration and thrombectomy (2 patients) and retransplantation (1 patient) had a 100% mortality rate. In particular, the mortality rate of patients with complete PVT with extension into the splanchnic veins is high (33%). Three-month and 4-year patient survival rates were statistically similar in the 3 groups. The presence of PVT at the time of OLT is not a contraindication for OLT. However, if PVT extends into the splanchnic veins, the outcome is guarded. (Liver Transpl 2001;7:125-131.)

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Section: Discussionmentioning

confidence: 55%

Liver transplantation in patients with portal vein thrombosis

Manzanet¹,

Sanjuan²,

Orbis³

et al. 2001

Liver Transpl

167

126

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“…Fortunately, there were no cases of tumor thrombus in PVT found during transplants in our series. It is rare for a tumor thrombus extending into the 16 mentioned that the preexisting PVT is no more contraindication in deceased donor liver transplantation. They reported 81% of 1-yr patient survival.…”

Section: Discussionmentioning

confidence: 99%

Single center experience of 39 patients with preoperative portal vein thrombosis among 404 adult living donor liver transplantations

et al. 2006

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Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) involves technical difficulty. The aim of this research was to analyze their preoperative diagnosis of PVT, operative procedures, and postoperative courses of patients with preoperative PVT. Thirty-nine patients of 404 adult patients (9.7%) undergoing LDLT in our hospital from 1996 June to 2004 December had PVT at their transplantation. Twenty-nine patients had intractable ascites, 21 had gastrointestinal bleeding, and 18 had encephalopathy. The thrombus was located in the portal trunk in 23, in the portal trunk and superior mesenteric vein (SMV) in 7, and developed into the SMV and the splenic vein in 8. The occlusive grade was partial in 29, and complete in 10 patients. The thrombus was removed by a simple technique, and eversion and/or incision technique, or total removal of the portal vein (PV). The PV was reconstructed with the thrombectomized native PV, with an interposed vein graft, or porto-caval hemitransposition. Advanced PVT had a significant impact on blood loss and hospital mortality. Three out of 10 patients with residual PVT required radiological and/or surgical intervention after transplantation. In conclusion, thorough planning is essential for a successful LDLT outcome for patients with preexisting PVT. Liver Transpl 12:1512-1518, 2006

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“…As the incidence of PVT reaches 15 YO in patients with chronic liver disease 123, 261 and ranges from 6 YO to 21 % in surgically treated cirrhotics [4, 261, several technical modifications had to be developed in order to allow allograft implantation [28][29][30]331. Despite the introduction of technical refinements, the operative mortality rates reported since 1990 remain high (range 9.1 YO-42 YO) in the presence of splanchnic thrombosis [7,10,16,22,29] (Table 4) and previous portosystemic shunting (range 7 %-33 %) [l, 5, 17, 21, 26, 321 ( Table 5). The prerequisites for successful liver transplantation in such cases are precise preoperative evaluation of the splanchnic veins and/or portosystemic shunt anatomy, as well as a standardized surgical approach.…”

Section: Discussionmentioning

confidence: 99%

“…None of the cancer patients had tumour thrombus in the portal vein. Five cirrhotic patients (10 YO) were classified Child Pugh A, 16 thrombosed portocaval shunt and two had a PVT following splenorenal shunting. These two patients were considered part of the PVT group because of the main repercussion of thrombosis on allograft implantation.…”

Section: Methodsmentioning

confidence: 99%

Adult liver transplantation and abnormalities of splanchnic veins: experience in 53 patients

et al. 1997

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The aim of this study was to analyze the influence of technical problems resulting from splanchnic venous anomalies on the outcome of orthotopic liver transplantation. From February 1984 until December 19953 Yo) of 326 adults underwent consecutive transplantations whilst having acquired anomalies of the splanchnic veins. These consisted of portal vein thrombosis ( n = 32, 9.8 YO), thrombosis with inflammatory venous changes (phlebitis; n = 6, 1.8 YO) and alterations related to portal hypertension surgery ( n = 15,4.6 YO). Because of major changes in surgical technique, i. e., eversion instead of blind venous thrombectomy, immediate superior mesenteric vein approach in cases of extended thrombosis, and piggyback implantation with preservation instead of removal of the inferior vena cava, patients were divided into two groups: those who underwent transplantation during the period February 1984 to December 1990 (group 1) and those transplanted between January 1991 and December 1995 (group 2). Surgical procedures to overcome the anomalies consisted of venous thrombectomy ( n = 26), implantation of the donor portal vein at the splenomesenteric confluence (n = 5 ) or onto a splenic ( n = 1) or ileal varix ( n = l), interposition of a free iliac venous graft between recipient superior mesenteric vein and donor portal vein ( n = 9,) and interruption of surgical portosystemic shunt (n = 13). All patients had a complete follow-up. The 1-and 5-year actuarial patient survival rates were similar in patients with ( n = 53) and without ( n = 273) splanchnic venous abnormalities (75.5 YO vs 78.1 % and 64.3 YO vs 66.9 %, respectively). Early ( < 3 months) post-transplant mortality was 24.5 YO (13/53 patients). Mortality was highest in the portal vein thrombophlebitis group (5/6,83.3 YO), followed by the portal hypertension surgery group (5/15,33.3 %) and the portal vein thrombosis group (3/32,9.4 Y ) . Technical modifications significantly reduced mortality in group 2 (10.3 Yo, 3/29 vs 41.7 YO, 10/24 patients in group 1; P < 0.05) as well as the need for re-exploration for bleeding (13.8 YO, 4/29 patients in group 2 vs 15/24,62.5 % in group 1; P < 0.01). Mortality directly related to bleeding was also significantly lowered (1/29,3.4 % in group 2 vs 91 24,37.5 % in group 1; P < 0.01). We conclude that liver transplantation can be safely performed in the presence of splanchnic vein thrombosis and previous portal hypertension surgery.

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A selective approach to preexisting portal vein thrombosis in patients undergoing liver transplantation

Cited by 59 publications

References 4 publications

Liver transplantation in patients with portal vein thrombosis

Liver transplantation in patients with portal vein thrombosis

Single center experience of 39 patients with preoperative portal vein thrombosis among 404 adult living donor liver transplantations

Adult liver transplantation and abnormalities of splanchnic veins: experience in 53 patients

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