Adult Living Donor Liver Transplantation for Patients With Portal Vein Thrombosis: A Single-center Experience

Abstract

BackgroundLiving donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) is associated with several technical challenges for its complicated procedures and poor outcomes. Some institutions still consider preexisting PVT as a relatively contraindication for LDLT.MethodsBetween April 2010 and May 2016, 129 adults underwent LDLT at our institution, and 28 (21.7%) of whom had preexisting PVT. Portal vein thrombosis was diagnosed using preoperative imaging techniques and intraoperative findings. The characteristics and outcomes of the cases were retrospectively evaluated.ResultsThe type of PVT included Yerdel grade 1 in 21 (75.0%) cases, grade 2 in 3 (10.7%) cases, and grade 3 in 4 (14.3%) cases. There were no cases of Yerdel grade 4 PVT. After removing thrombus inside the vessel, we performed simple portal vein anastomosis in 25 (89.3%) cases, patch technique with vascular graft in 1 case (3.6%), and an interposition technique with vascular graft in 2 cases (7.1%). Compared with the non-PVT group, cold ischemic time was longer (P = 0.012) and the rate of postoperative PVT was higher (P = 0.001) in PVT group. In the comparison between the recipient without and with postoperative PVT, the existence of preoperative PVT was the independent risk factor in the multivariate analysis (hazard ratio, 7.511; 95% confidence interval 1.382-40.820; P = 0.020).ConclusionsAlthough it had a technically complicated operation, LDLT could be safely performed in the patients with PVT in our institution.

Novel classification of non-malignant portal vein thrombosis: A guide to surgical decision-making during liver transplantation

“…Optimal outcomes with these approaches have been reported extensively and will not be discussed here. [21][22][23][24][25][26]…”

Renoportal Anastomosis During Liver Transplantation in Patients With Portal Vein Thrombosis

“…Nonmalignant portal vein thrombosis (PVT) in candidates for LT was recently dichotomized into noncomplex 2 (Yerdel 3 grades 1-3) and complex (Yerdel grade 4, i.e., diffuse portomesenteric thrombosis with or without a large portosystemic shunt (spontaneous or surgical). Results of LT similar to those achieved in patients without PVT were repeatedly reported in patients with noncomplex PVT, i.e., when the native portal vein can be recanalized to allow porto-portal reconstruction (also called anatomical reconstruction, with or without an interposed graft) or when the native distal superior mesenteric vein can be anastomosed, usually with a jump-graft, to the graft portal vein [4][5][6][7][8][9][10] . The prevalence of complex PVT at the time of LT ranges from 0% to 3% 2 .…”

“…Results of LT similar to those achieved in patients without PVT were repeatedly reported in patients with noncomplex PVT, that is, when the native portal vein can be recanalized to allow portoportal reconstruction (also called anatomical reconstruction, with or without an interposed graft) or when the native distal superior mesenteric vein can be anastomosed, usually with a jump-graft, to the graft portal vein. [4][5][6][7][8][9][10] The prevalence of complex PVT at the time of LT ranges from 0% to 3%. 2 Arguing of the current graft shortage, most LT centers remain reluctant to indicate LT for patients with complex PVT 11 because of the increased morbidity and mortality due to residual or even exacerbated portal hypertension (PHT).…”

Portal Vein Complications After Adult Living Donor Liver Transplantation: Time of Onset and Deformity Patterns Affect Long‐Term Outcomes

“…The surgical procedures for LDLT at our institution have been described previously. ( 16 ) In brief, PV reconstruction was performed in end‐to‐end fashion between the donor and recipient PVs using continuous 6‐0 monofilament sutures (PDS ® or PROLENE ® ). When PVT was detected intraoperatively, we first attempted thromboendovenectomy; when sufficient portal flow (so‐called front flow) was confirmed, direct PV anastomosis was performed.…”