Management of portal vein thrombosis after liver transplantation with a combined open and endovascular approach

Kensinger, Clark D.; Sexton, Kevin W.; Baron, Christopher M.; Lipnik, Andrew J.; Meranze, Steven G.; Gorden, D. Lee

doi:10.1002/lt.24011

Cited by 16 publications

(13 citation statements)

References 5 publications

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“…In the present study, the occurrence of vascular complications was very low and comparable to that found in former studies. 28 – 30 Hepatic artery thrombosis and/or stenosis were the most commonly observed vascular complications (3.4% of cases). In general, vascular complications occurred with a very low incidence, making it infeasible to evaluate their role in the development of acute rejection.…”

Section: Discussionmentioning

confidence: 99%

Acute allograft rejection in liver transplant recipients: Incidence, risk factors, treatment success, and impact on graft failure

et al. 2018

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ObjectiveThis study was performed to identify risk factors for acute cellular rejection after liver transplantation (LT).MethodsConsecutive LT recipients who underwent surgery in our institution from 2002 to 2015 were retrospectively evaluated.ResultsIn total, 176 patients were eligible for statistical analysis. During a mean observation period of 61.1 ± 36.3 months, 43 episodes of acute rejection were evident. Of these, 34 (79.0%) were responsive to methylprednisolone, 3 (7.0%) were treated by adjusting the dosage of immunosuppressive agents, and 6 (14.0%) were methylprednisolone-resistant and treated using anti-thymocyte globulin. Biliary complications (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 2.00–11.98); donor-negative, recipient-positive CMV mismatch (OR = 9.88, 95% CI = 1.18–82.36); sex mismatch (OR = 3.16, 95% CI = 1.31–8.10); and sex mismatch with a female donor (OR = 3.00, 95% CI = 1.10–7.58) were identified as significant risk factors for acute graft rejection after LT.ConclusionIn patients who develop acute cellular rejection after LT, biliary complications should be evaluated as a potential cause. Most acute rejections after LT respond to bolus corticosteroid therapy.

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Section: Discussionmentioning

confidence: 99%

Acute allograft rejection in liver transplant recipients: Incidence, risk factors, treatment success, and impact on graft failure

et al. 2018

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“…According to previous studies, risk factors associated with post‐operative PVT included technical causes, preoperative PVT and shunting procedures, discrepancy in portal vein (PV) diameter and intraoperative PV reconstruction. With regard to the characteristics and similarity of vascular complications after OLT, other potential factors including donor‐ and recipient‐related, intraoperative and post‐operative elements were taken into consideration, including recipient age, recipient/donor weight, ratio, model for end‐stage liver disease score, Child‐Pugh score, surgery history, donor age, pre‐transplant PVT, anhepatic phase, intraoperative erythrocyte, intraoperative platelet, cold ischaemia time, operation time, episode of rejection, post‐operative erythrocyte and post‐operative platelets …”

Section: Methodsmentioning

confidence: 99%

Analysis of portal vein thrombosis after liver transplantation

Xue

Zhang

et al. 2019

ANZ Journal of Surgery

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Background: Portal vein thrombosis (PVT) is one of the most deadly complications after orthotopic liver transplantation (OLT). This study aimed to identify risk factors and summarize the experience of PVT management after OLT. Methods: The clinical data of 407 adult patients received OLT from July 2011 to December 2015 was retrospectively investigated. Results: The incidence rate of PVT was 2.9% (12/407). Pre-transplant PVT (P = 0.001), post-operative transfusion of erythrocyte (P = 0.006) and platelet (P = 0.036) were significantly associated with PVT in the univariate analysis and the appearance of pre-transplant PVT (P = 0.002, odds ratio 6.05) was the independent risk factor according to binary logistic regression. Among patients with PVT, three cases (3/12) received balloon dilation through selective catheterization of portal vein, five (5/12) received balloon-expandable stent placement, three (3/12) received thrombectomy and surgical revascularization and one (1/12) received retransplantation. Six patients (6/12) died from various complications and the remaining six were followed up with normal liver function and patent portal vein. Conclusions: The risk factors were pre-transplant PVT and post-operative transfusion of erythrocyte and platelet. To recipients with high risk, early diagnosis and prompt management of PVT are essential to improve prognosis.

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“…Therapeutic options for PVT range from systemic anticoagulation, catheter-based thrombolytic therapy via transjugular intrahepatic portosystemic shunt (TIPS), to surgical revision until retransplantation. The best three percutaneous options in literature are transhepatic vein angioplasty (with or without stent placement), percutaneous thrombolytic treatment via TIPS, and transsplenic approach [53,54].…”

Section: Portal Vein Thrombosis (Pvt)mentioning

confidence: 99%

Early Postoperative Monitoring of the Liver Graft

Civantos¹,

Cantero²,

Marcos³

et al. 2021

Liver Pathology

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Liver transplantation (LT) is a common current technique for end-stage liver disease. Complications after the surgical procedure, though uncommon, can be of very different origin and can also be severe enough to lead to liver and multiorgan failure and finally graft loss and/or recipient's death. Intensivists and the surgical team must be familiarized with these early complications to detect them as soon as possible in order to use the best diagnostic tools and take the best therapeutic measures to restore anatomical integrity and organ function to optimize the liver graft. In this chapter, we present an updated state of the art for efficiently tackling with all different, most usual complications that an LT patient can present during early postoperative period.

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Management of portal vein thrombosis after liver transplantation with a combined open and endovascular approach

Cited by 16 publications

References 5 publications

Acute allograft rejection in liver transplant recipients: Incidence, risk factors, treatment success, and impact on graft failure

Acute allograft rejection in liver transplant recipients: Incidence, risk factors, treatment success, and impact on graft failure

Analysis of portal vein thrombosis after liver transplantation

Early Postoperative Monitoring of the Liver Graft

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