Eversion Thrombectomy for Portal Vein Thrombosis During Liver Transplantation

Abstract

Portal vein thrombosis (PVT) has been seen as an obstacle to orthotopic liver transplantation (OLT), but recent data suggest that favorable results may be achieved in this group of patients. The aim of this study was to analyze the incidence, management, and survival of patients with PVT undergoing primary OLT with thrombectomy. Between October 1990 and August 2000, 468 liver transplantations were performed in our center and portal vein thrombosis was present in 38 patients (8.1%). Preoperative diagnosis, extension, intraoperative management, postoperative recurrence of portal vein thrombosis, and 1-year actuarial survival rates were retrospectively studied. Preoperative diagnosis was made in 17 cases (44.7%). In all patients, portal flow was restored after portal vein thrombectomy, followed by usual end-to-end portal anastomosis. All patients received preventive low-weight heparin from day 2 to hospital discharge, and then aspirin. Rethrombosis was observed in one patient with extended splanchnic thrombus. The 1-year actuarial patient survival rate was 83.7%, and did not significantly differ from the patients without portal vein thrombosis (86.7%). Our results suggest that portal vein thrombosis is often partial and thus difficult to diagnose preoperatively; it can be managed successfully during surgery by thrombectomy, except when there is complete splanchnic veins thrombosis; and it did not affect 1-year survival.

Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?

“…At the time of listing patients for transplantation at our center, routine pre-operative review of all imaging is performed to prepare for intra-operative and anatomic challenges. Our findings are supported by other series that have demonstrated excellent outcomes with operative thrombectomy in patients with preop PVT [20,21].…”

Portal Vein Thrombosis in Cirrhosis

“…Even in patients undergoing systematic ultrasound at close intervals of three months, the rate of previously unrecognized thrombosis remains relatively high. 13 In patients waiting for transplant, the 12-month risk incidence of developing PVT has been reported in one study to be 7%. 3 …”

“…In recent series, up to 50% of patients with PVT were detected for the first time at the time of transplant surgery. 3,13 This may be due to either false negatives on imaging or to PVT occurring while on the waiting list. Even in patients undergoing systematic ultrasound at close intervals of three months, the rate of previously unrecognized thrombosis remains relatively high.…”

“…In fact a significant proportion of patients (up to 50%) with PVT at the time of transplant surgery were previously unrecognized. 3,13 The impact of PVT on the outcome of cirrhosis is not been investigated systematically. Maruyama et al in their series of 150 patients showed that grade of ascites was significantly worse and spleen size was significantly larger in the PVT group.…”

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

“…Surgical innovations have been reported for hilum dissection, thrombectomy and portal vein reconstruction using vein grafts in deceased liver transplantation. [1][2][3][4][5][6][7][8][9][10][11][12][13] In living donor liver transplantation (LDLT), there are technical difficulties due to these challenges for preexisting PVT patients; necessity of distal dissection of vascular pedicle of the hilum and restricted availability of a vein graft. The presence of PVT in the recipient has frequently been presented as a relative or absolute contraindication in LDLT by numerous groups.…”