Clinical analysis of living donor liver transplantation in patients with portal vein thrombosis

Abstract

The aim of this study was to improve outcomes in living donor liver transplantation (LDLT) patients with portal vein thrombosis (PVT). Of 246 adult patients who underwent LDLT with a right lobe graft between January 2000 and May 2007, PVT was diagnosed in 50 patients (20.3%), who were further subdivided into partial (n = 39, 78%) and complete (n = 11, 22%) types. Patients with PVT, especially complete PVT, showed high incidences of variceal bleeding (p = 0.021), operative RBC transfusion (p < 0.046) and a post-transplantation complications related to bleeding (p = 0.058). We also classified PVT according to its location and the presence of collaterals: type I (n = 41, 82%): PVT localized above the confluence of the splenic and superior mesenteric veins (SMV); type II (n = 7, 14%): PVT extending below the confluence with a patent distal SMV; type III (n = 2, 4%): complete portal vein and SMV thrombosis except for a coronary vein. LDLT could be safely undertaken in patients with PVT without increased mortality. In our type II and III PVT, when thrombectomy fails, jump grafting using a cryopreserved vessel may serve as a reliable alternative method to restore portal flow.

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

“…Three papers compared the 1-year survival between the LT recipients with partial PVT and those without PVT [36,38,39]. All of them demonstrated that this was mildly higher in patients with partial PVT than in those without PVT (in the paper by Suarez Artacho: 82.1% versus 70.9% [36]; in the paper by Kim: 89.5% versus 89.1% [38]; in the paper by Ravaioli: 88% versus 86% [39]). But none of them showed a statistically significant association.…”

“…Four papers compared the 1-year survival between the LT recipients with complete PVT and those without PVT [34,36,38,39]. The test for heterogeneity was not statistically significant (I²=21.1%, P=0.283).…”

“…Five studies regarding LT performed after 2000, compared the 1-year survival between the LT recipients with and without PVT [29,31,33,38,40]. The test for heterogeneity was not statistically significant (I²=0%, P=0.659).…”

Outcome of modified portal vein anastomosis for recipients with portal vein thrombosis or stenosis before living donor liver transplantation

“…Regarding the type of vessel grafts, we think the donor IMV is the most ideal graft in Type-1 or -2 m-PVa because it is not only suitable for diameter and length but also safely obtained from the same surgical field. In recent years, the use of cryopreserved veins are reported to be useful from limited centers, but long-term outcome remains unstudied [8,9]. In our series, the portal vein reconstruction using shunt vessel (Type-3) was useful for the extended PVT recipients with huge shunt vessel, resulting to no experience of postoperative complications.…”

“…Portal vein reconstruction requires a huge shunt vein when the PVT is extended to the bifurcation and accompanied by cavernous transformation. The potential surgical options for advanced PVT cases include different types of venous jump graft reconstruction or arterializations of the portal vein [8]. Cavoportal hemitransposition or renoportal anastomosis [3] had been recently advocated as creative surgical strategies.…”