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

Abstract

PurposePortal vein thrombosis (PVT) has been considered a relative contraindication for living donor liver transplantation (LDLT). However, it is no longer a contraindication of LDLT due to improvement in surgical techniques and approaches to PVT. The aim of this study was to assess the impact of PVT on outcomes in LDLT patients.MethodsWe retrospectively analyzed the data from 97 adult patients undergoing LDLT in our center from July 2008 to June 2010. Intraoperative findings and preoperative imaging results were reviewed for PVT grading (Yerdel grading). We analyzed the technical aspects and comparisons of risk factors, perioperative variables, and survivals between patients with and without PVT based on the grades.ResultsIn the 97 LDLT patients, 18 patients were confirmed to have PVT (18.5%) including grade I cases (n = 8), grade II (n = 7), and grade III (n = 3). Prior treatment of portal hypertension was found to be an independent risk factor for PVT (P = 0.001). The comparisons between PVT and no PVT groups showed no significant difference in intraoperative and postoperative variables except for postoperative bleeding (P = 0.036). The short-term portal vein patency, in-hospital mortality and survival rates were not significantly different between the PVT and control groups.ConclusionThe outcomes are similar to non-PVT group in terms of in-hospital mortality, survival rates, and postoperative complications. Therefore, our study suggests that PVT cannot be considered to be a contraindication for LDLT and LDLT could be undertaken without increased morbidity and mortality in patients with PVT, in spite of operative complexity.

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

“…Two studies, in which LT was performed after 2000, compared the in-hospital survival between the LT recipients with and without PVT [28,37]. Both of them reported a statistically similar in-hospital survival between the two groups (95.5% versus 90.9%; 94.4% versus 96.2%).…”

“…Seven papers compared the in-hospital survival between the total LT recipients with and without PVT [16,18,27,28,37,39,41]. The heterogeneity was moderate (I²=54.7%, P=0.04).…”

Portal vein reconstruction in adult living donor liver transplantation for patients with portal vein thrombosis in single center experience

“…In the LDLT setting, there exist additional challenges in acquiring appropriate vein grafts, obtaining adequate portal flow, releasing portal hypertension, and preventing the development of small‐for‐size syndrome. Few papers have reported a systematic strategy and LDLT outcomes for patients with PVT .…”

“…It is more difficult to find appropriate vein grafts and reconstruct the PV in living donor liver transplantations (LDLTs) than in DDLTs. Few papers have reported systematic strategies regarding LDLTs and outcomes in patients with PVT . Here, we introduce our current strategy of LDLT for PVT patients while considering the following factors: the extent/localization of the thrombus according to Yerdel's classification, hemodynamics, intraoperative control of PV pressure, and the postsurgical management of complications.…”

Successful living donor liver transplantation with cavoportal hemitransposition in diffuse portomesenteric thrombosis

“…This led them to conclude that end-to-end CPHT might be a contraindication to adult LDLT with a hemiliver. In another article, Kim et al 10 reported their experience of 18 patients with PVT in a series of 97 LDLT recipients. No patient underwent CPHT in their series.…”