Liver transplant in patients with portal vein thrombosis: Medical and surgical requirements

PRO: Portal Vein Thrombosis Impacts Liver Transplantation Outcomes

“…PVT remains a common problem in patients with cirrhosis, with an estimated prevalence rate in those awaiting LT of 2% to 26%,1,2 which is thought to parallel the prevalence of disease in all patients with cirrhosis 3. Previously considered a contraindication to LT, the presence of nonmalignant PVT no longer precludes transplantation, as indicated by a 1985 report detailing successful revascularization,4 but peritransplant outcomes in those with PVT still remain inferior compared with those without PVT, particularly in patients with complete occlusion of the PV or use of nonphysiological vascular reconstruction 3,5,6…”

“…5 Nonphysiological vascular reconstructions have also been described with reports of aneurysmal dilation, 3 rethrombosis of veins, unresolved portal hypertention, 10 and increased morbidity and mortality. 3,6,10 For example, in a single-center cohort of 1379 liver transplant recipients, Hibi et al 10 reported the 1-year patient survival • Higher resource utilization (increased transfusion requirements, need for hemodialysis) and postoperative complications (primary nonfunction, rethrombosis) in recipients with PVT compared with those without PVT.…”

Management of Portal and Mesenteric Venous Thrombosis

“…65,66 Many patients with cirrhosis who develop a PVT are asymptomatic due to splanchnic decompression through an existing spontaneous portosystemic shunt, and the PVT is discovered incidentally detected on routine US screening for HCC. 1 Some patients may also present with symptoms of abdominal discomfort or in the setting of hepatic decompensation, such as new or worsening ascites or gastrointestinal bleeding. 11 In the setting of cirrhosis, cross-sectional imaging with CT or MRI is important to confirm the diagnosis of PVT and also rule out HCC, which can result in tumor thrombus and impact management.…”

“…Particularly in the cirrhotic population, PVTs are often asymptomatic and found incidentally on ultrasounds (USs) for hepatocellular carcinoma (HCC) screening. 1 If the acute thrombosis persists, and there is no recanalization of the vasculature generally within a couple of months, collaterals develop in a process referred to as cavernous transformation. While chronic PVT is a term that has been used to refer to this state, it is not felt to be as factually accurate as either cavernous transformation or cavernoma.…”

Extensive Thrombectomy as a Legitimate Strategy in Living Donor Liver Transplantation With Advanced Portal Vein Thrombosis

“…(3,4) Therefore, anticoagulant and antiplatelet therapy options should be given for at least 3-6 months in patients with PVT. (5,6) Table 1 shows that the authors measured portal vein pressure (mm Hg) and portal vein flow (L/minute). However, it was not specified which instrument was used for these measurements.…”