Successful Living Donor Liver Transplantation in Portomesenteric Thrombosis

Abstract

Chronic portal vein thrombosis (PVT) is often considered a relative contraindication for living donor liver transplantation due to the risks involved and higher morbidity. In this report, we describe a surgical strategy for living donor liver transplant in patient with complete PVT using venovenous bypass from the inferior mesenteric vein (IMV) and then using a jump graft from the IMV for portal inflow into the graft. IMV is a potential source for portal inflow in orthotopic liver transplant.

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

“…If an adequate flow cannot be achieved or a low dissection of the retropancreatic PV or distal SMV part is required, a jump graft or polytetrafluoroethylene graft from the SMV to the donor PV will be necessary . In grade IV patients, the PV can be anastomosed to a patent splanchnic tributary, for example, the coronary vein or a large collateral vein (diameter of 2 cm or more) . If the portal inflow after these methods was suboptimal or PV cannot be anastomosed, PV arterialization is a simple and effective method of augmenting suboptimal portal inflow in end‐to‐end or end‐to‐side anastomosis.…”

“…81,82,84 In grade IV patients, the PV can be anastomosed to a patent splanchnic tributary, for example, the coronary vein or a large collateral vein (diameter of 2 cm or more). 4,82,[85][86][87] If the portal inflow after these methods was suboptimal or PV cannot be anastomosed, PV arterialization is a simple and effective method of augmenting suboptimal portal inflow in endto-end or end-to-side anastomosis. A disadvantage, however, is that it leaves the portal hypertension unchanged, and overarterialization of the liver can eventually lead to fibrosis.…”

A Surgical Technique for Portal Vein Decompression in Retransplantation

“…Our technique differs from the conventional use of IMV in venovenous bypass which requires an additional cannulation of the femoral vein to sustain the circulating volume of blood required in venovenous bypass. 4,5 The use of the cell saver to collect the IMV blood adds essentially no change in its primary use. We did not observe any obvious hemodynamic changes during the procedure when the cell saver was used for decompression.…”

Usefulness of Artificial Jump Graft to Portal Vein Thrombosis in Deceased Donor Liver Transplantation

“… 2 Additionally, blood loss volumes in patients with complete thrombosis were reported to be significantly higher than those in patients without PVT or with partial PVT. 3 Nevertheless, the presence of PVT is no longer considered an absolute contraindication for liver transplantation, as many improvements have been made in surgical technique and perioperative management. 2 In this report, we describe using polytetrafluoroethylene (PTFE) jump graft from the inferior mesenteric vein (IMV) for portal inflow in a patient with severe portomesenteric venous thrombosis.…”