Portal Vein Thrombosis and Liver Transplantation: Long Term

Abstract

Obstruction of the portal vein may be related to constriction by malignant tumors or thrombosis associated with liver disease. We herein have reported our experience with patients undergoing liver transplantation with portal vein thrombosis (PVT) whose diagnosis was made intraoperatively. From September 1991 to May 2009, we studied 27/419 (6.4%) patients with PVT who were evaluated according to the presence of esophagogastric varices, underlying disease, malignancy, and if there was previous surgery, review of medical records on data collected prospectively. We observed 24 (88.9%) patients with PVT grade 1, 2 (7.4%) with grade 2, and 1 (3.7%) with grade 3. The average age of the PVT patients was 47.5 years; the average model for End-Stage Liver Discase score was 18.3, and the predominant diagnosis, hepatitis C cirrhosis. Eighteen underwent a sclerotherapy/ligature. The sensitivity of ultrasound for grade 1 thrombosis was 39.1%; for grade 2, 50%; and for grade 3, 100%. Portal vein thrombectomy was performed in 24 patients. In other patients (grade 2), we performed an anastomosis of the donor portal vein to the recipient gastric vein or to a greater splanchnic collateral vein. In only 1 patient was the graft performed using the donor portal vein-donor iliac vein-recipient superior mesenteric vein. None of the patients displayed PVT in the immediate postoperative period. Actuarial survivals at the years 1, 3, and 5 were 85%, 74%, and 63%, respectively. We concluded that PVT cannot be considered to be a contraindication for liver transplantation.

An early single-center experience of portal vein thrombosis in living donor liver transplantation: clinical feature, management and outcome

“…The etiology is not completely understood, but is believed to be related to anatomic change in the liver owing to the cirrhotic process, increased portal pressure, endothelial injury or coagulation changes [1,15,17,18]. In past studies, high-risk factors for developing PVT included autoimmune hepatitis, cryptogenic cirrhosis, chronic active hepatitis, Budd-Chiari syndrome, male gender, increased age, trauma, hypercoagulative states, Child-Pugh C, and treatment of portal hypertension (splenectomy, shunt operation, TIPS) [4,14,15,19].…”

Portal vein thrombosis in liver cirrhosis

“…The increased mortality and morbidity rates associated with PVT are mostly restricted to the first year after liver transplantation [4,62] and actuarial survival after 1 year is good. Therefore, PVT cannot be considered to be a contraindication to liver transplantation [71] . Anticoagulation therapy is of proven benefit in patients with acute deep vein thrombosis [72] .…”

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

“…The present study found that of 56% recipients with m-PVa had episodes of treatment of portal hypertension before LDLT. There are several risk factors for PVT, such as advanced age, Child-Pugh C, previous treatment of portal hypertension (sclerotherapy, Transjugular intrahepatic portosystemic shunt, shunt surgery, splenectomy), and previous surgical interventions [6]. The treatments of portal hypertension may change the hemodynamic state to low perfusion or reversed flow in the PV [7].…”