Alternative forms of portal vein revascularization in liver transplant recipients with complex portal vein thrombosis

Suárez, Y. Fundora; Hessheimer, Amelia J.; Prete, Luca Del; Maroni, Lorenzo; Lanari, Jacopo; Barrios, Oriana; Clarysse, Mathias; Gastaca, Mikel; Gómez, Manuel Ángel Barrera; Bonadona, Agnès; Janek, Julius; Bosca, A. Ramirez; Martínez, J. M. Álamo; Zozaya, Gabriel; Garnica, Dolores López; Magistri, Paolo; León, Francisco de; Magini, Giulia; Patrono, Damiano; Ničovský, Jiří; Hakeem, A.; Nadalin, Silvio; McCormack, Lucas; Palacios, Pilar Tejada; Zieniewicz, Krzysztof; Blanco‐Fernández, Gerardo; Nuño, Javier; Pérez-Saborido, B.; Echeverri, Juan; Bynon, John S.; Martins, Paulo N.; López, Víctor; Dayangaç, Murat; Lodge, J. Peter A.; Romagnoli, Renato; Toso, Christian; Santoyo, Julio Santoyo; Benedetto, Fabrizio Di; Gómez‐Gavara, Concepción; Rotellar, Fernando; Bravo, Miguel Ángel Gómez; Andújar, Rafael López; Girard, Édouard; Valdivieso, A.; Pirenne, Jacques; Lladó, Laura; Germani, Giacomo; Cescon, Matteo; Hashimoto, Koji; Quintini, Cristiano; Cillo, Umberto; Polak, Wojciech; Fondevila, Constantino

doi:10.1016/j.jhep.2023.01.007

Cited by 9 publications

(3 citation statements)

References 34 publications

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“…For example, known mesenteric shunts can be used as inflow source directed to the liver by constructing a direct anastomosis to the graft PV, or with the interposition of a conduit 14 . Consistently, a renoportal anastomosis can achieve good post-LT outcomes, even comparable to the outcomes of patients without PVT, when performed in presence of significant spontaneous splenorenal shunts 15 , 16 . In line with this, PCHT is a reconstruction strategy that can be adopted as a rescue strategy in selected cases, again taking advantage from the presence of splenorenal shunts.…”

Section: Discussionmentioning

confidence: 62%

Portal vein thrombosis and liver transplantation: management, matching, and outcomes. A retrospective multicenter cohort study

Di Benedetto,

Magistri,

Di Sandro

et al. 2024

International Journal of Surgery

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Background and aims: Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients. Methods: Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant. Results: Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis. Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT (P<0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present. Conclusions: Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3–4.

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Section: Discussionmentioning

confidence: 62%

Portal vein thrombosis and liver transplantation: management, matching, and outcomes. A retrospective multicenter cohort study

Di Benedetto,

Magistri,

Di Sandro

et al. 2024

International Journal of Surgery

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“…17 However, the non-physiological PV reconstruction may be the last option for patients with complicated PVT, which is the only factor significantly and independently associated with allcause graft loss (hazard ratio [HR]: 6.639). 18 Furthermore, patients with occlusive PVT who received LT had an approximately 5-7-fold increased short-term risk of death. 19 Other events, including the 5-year cumulative risk of depression, anxiety, and bone fractures, were significantly higher (approximately twofold).…”

Section: Influence Of Pvt On Decompensating Events and Mortalitymentioning

confidence: 99%

“…Specifically, physiological PV reconstruction is the ideal technique during LT; although there is some difficulty, it seems feasible in Grade I–III Yerdel 17 . However, the non‐physiological PV reconstruction may be the last option for patients with complicated PVT, which is the only factor significantly and independently associated with all‐cause graft loss (hazard ratio [HR]: 6.639) 18 . Furthermore, patients with occlusive PVT who received LT had an approximately 5–7‐fold increased short‐term risk of death 19 .…”

Section: Epidemiology and Influence Of Pvt In Liver Cirrhosismentioning

confidence: 99%

Portal vein thrombosis in liver cirrhosis: An updated overview

Xiao

Wang

2023

Portal Hypertension & Cirrhosis

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Portal vein thrombosis (PVT) is a frequent and severe complication in patients with cirrhosis; however, the pathophysiology of PVT needs to be better clarified. There are few significant predictive factors in clinical practice, and the impact of PVT on cirrhosis progression and its complications, such as gastrointestinal bleeding, hepatic encephalopathy, and hepatorenal syndrome, remains uncertain. In recent years, the understanding of the mechanisms of PVT has become more profound with the publication of related literature. Therefore, in this review, we aim to summarize the advanced progress in the epidemiology, hazards, risk factors, diagnosis and classification, and treatment of PVT to provide insight into clinical management.

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Non-contrast-enhanced MR angiography of left gastric vein in patients with gastroesophageal varices: morphology and blood supply analysis

Zou,

Liu,

Tan

et al. 2023

Eur Radiol

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Alternative forms of portal vein revascularization in liver transplant recipients with complex portal vein thrombosis

Cited by 9 publications

References 34 publications

Portal vein thrombosis and liver transplantation: management, matching, and outcomes. A retrospective multicenter cohort study

Portal vein thrombosis and liver transplantation: management, matching, and outcomes. A retrospective multicenter cohort study

Portal vein thrombosis in liver cirrhosis: An updated overview

Non-contrast-enhanced MR angiography of left gastric vein in patients with gastroesophageal varices: morphology and blood supply analysis

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