Living Donor Liver Transplantation for the Patients With Portal Vein Thrombosis: Use of an Interpositional Venous Graft Passed Posteriorly to the Pancreatic Parenchyma Without Using Jump Graft

Mizuno, Shugo; Murata, Yasuhiro; Kuriyama, Naohisa; Ohsawa, Ichiro; Kishiwada, Masashi; Hamada, Takeomi; Usui, Miki; Sakurai, Hiroyuki; Tabata, Masami; Isaji, Syuji

doi:10.1016/j.transproceed.2012.01.039

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…For Yerdel grades 3 or 4, a more extensive and technical surgical strategy is often needed. Although we have described our techniques used for Yerdel grades 3 or 4, other sources in the literature have also reported various techniques, such as an interposition graft using a native or jump graft, renoportal anastomosis, portocaval hemitransposition, portal arterialization, or multivisceral transplant …”

Section: Discussionmentioning

confidence: 99%

The friendly incidental portal vein thrombus in liver transplantation

et al. 2015

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Improved outcomes have been shown in liver transplantation (LT) with portal vein thrombosis (PVT). However, PVT is still discovered incidentally during surgery despite careful preoperative imaging. Data are limited comparing the outcomes of incidental PVT with PVT diagnosed via preoperative imaging before LT. This study aims to compare the overall outcomes of patients with PVT. From 2008 to 2012, 369 patients had LT, and 58 patients with PVT were identified. They were divided into those with non-PVT (group 0; n 5 311), preoperatively identified PVT (group 1; n 5 28), and incidental PVT (group 2; n 5 30). The demographics, characteristics, preoperative assessment, and postoperative outcomes were compared. A survival analysis was also performed. Baseline characteristics and preoperative evaluations of all 3 groups were comparable (P > 0.05) except for Model for End-Stage Liver Disease score, tumor status, platelet levels, and serum bilirubin. A multivariate analysis only showed a high serum bilirubin level to be a predictor of PVT (P 5 0.004; odds ratio, 3.395; 95% confidence interval, 1.467-7.861). Postoperative outcomes were also comparable (P > 0.05). Compared to group 2, group 1 had more patients with a Yerdel classification of 3 or 4 with more extensive surgical intervention required (P 5 0.02). The survival analysis in all 3 groups was comparable with 5-year survival rate of 87.4%, 84.6%, and 91.8% in group 0, 1, and 2, respectively (P 5 0.66). In conclusion, recipients with PVT undergoing LT can have similar outcomes as the non-PVT patients even if PVTs were discovered incidentally. Discovery of incidental PVT only requires thrombectomy with no substantial change of treatment strategy, and the outcome is not adversely affected because most incidental PVTs are of a lower Yerdel grade. Preoperative imaging is useful to identify those with a higher Yerdel grade to allow planning of surgical strategy during transplantation. Liver Transpl 21:944-952, 2015. V C 2015 AASLD.Received December 7, 2014; accepted April 12, 2015.Recent studies have shown that portal vein thrombosis (PVT) is feasible in liver transplantation (LT) compared to the past, where it was once considered a contraindication because of technical difficulty and was associated with a high mortality and morbidity. The early era of PVT management in LT showed significant mortality and morbidity. However, with improved surgical techniques, technical capabilities, and surgical innovations, we have seen a marked improvement in the management of PVT with lower mortality and morbidity as shown in recently published data. 1,2 The incidence of PVT has been reported to be approximately 2%-26% in various studies. 3,4 Therefore, a good preoperative plan and strategy for identifying patients undergoing LT with PVT are vital to ensure good perioperative outcome and long-term consequences. Despite careful preoperative planning

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Section: Discussionmentioning

confidence: 99%

The friendly incidental portal vein thrombus in liver transplantation

et al. 2015

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“…In 2012, Mizuno et al reported their experience with three patients who underwent living donor LT: PVT was treated with an interpositional vascular conduit passing posterior to the pancreatic parenchyma without using a jump graft [ 7 ]. In detail, an external iliac vein (or internal jugular vein) graft was harvested and passed posterior to the pancreas for anastomosis to the cut end of the SMV.…”

Section: Resultsmentioning

confidence: 99%

Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation

Magistri

Tarantino

Olivieri

et al. 2018

Case Reports in Surgery

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Background In the context of cirrhosis, portal vein thrombosis (PVT) is present in 2.1% to 26% of patients. PVT is no longer considered an absolute contraindication for liver transplantation, and nowadays, surgical strategies depend on the extent of PVT. Complete PVT is associated with higher morbidity rates and poor prognosis, while comparable long-term outcomes can be achieved as long as physiological portal inflow is restored. Materials and Methods We report our experience with a 45-year-old patient undergoing liver transplant with a PVT (stage III-b). To restore portal vein inflow to the liver, an extra-anatomic jump graft from the right colic vein with donor iliac vein interposition was constructed. Results The patient recovered well, with a progressive improvement of the general conditions, and was finally discharged on p.o.d. 14. No anastomotic defects were found at the postoperative CT scan 10 months after the surgery. Conclusion Our technical innovation represents a valid and safe alternative to the cavoportal hemitransposition, providing a proper flow restoration and reproducing a physiological setting, while avoiding the complications related to the cavoportal shunt. We believe that the reconstitution of liver portal inflow should be obtained with the most physiological approach possible and considering long-term liver function.

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“…The pullout method, previously employed in a pediatric patient with PV obstruction [ 3 ], is dangerous for adult patients because collateral vessels usually develop around the SMV/SpV confluence. Mizuno et al reported a similar method in three adult cases of PV thrombosis [ 7 ]. Technical tips of the method are as follows.…”

Section: Discussionmentioning

confidence: 99%

Retro-pancreatic pull-through reconstruction of the hypoplastic portal vein using the autologous mesosystemic shunt vessel in adult living donor liver transplantation: a case report

Sugenoya,

Mita,

Shimizu

et al. 2024

surg case rep

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Background In liver transplant patients with hypoplastic portal vein (PV), when the narrowed segment is extended too deep into the dorsal side of the pancreas, it is difficult and dangerous to reconstruct the interposition graft from the upper part of the pancreas. Herein, we present a case of PV reconstruction with the autologous mesosystemic shunt vessel from the caudal side of the pancreas in a situation where the narrowed PV was deep, and we discuss the technical details. Case presentation A 25-year-old woman presented with cholestatic liver cirrhosis due to biliary atresia after Kasai procedure. Since her jaundice progressed, she was referred to our hospital for liver transplantation. Laboratory tests showed that her total bilirubin was elevated to 7.6 mg/dL. The Model for End-Stage Liver Disease score was 18, and the Child–Pugh score was 9 (Grade B). She underwent living donor liver transplantation (LDLT) using a right hemi-liver graft procured from her 54-year-old mother. The conventional approach from the cephalad side to the superior mesenteric vein (SMV) and splenic vein (SpV) confluence behind the pancreas was extremely difficult in this case because the confluence of SMV and SpV was close to the lower edge of the pancreas. Therefore, we decided to perform PV reconstruction from the caudal side. The main trunk of PV was documented as narrow (5 mm in diameter), for which retro-pancreatic pull-through PV reconstruction was successfully performed using her own mesosystemic shunt vessel. A contrast computed tomography (CT) scan was performed on postoperative day 5 because of an elevation of D-dimer and found a partial thrombus in the left pulmonary artery, as well as in the PV and left renal vein. Thereafter, thrombolytic therapy with low-molecular-weight heparin was started immediately and switched to a direct oral anticoagulant. The follow-up CT taken 3 months after liver transplantation revealed a patent PV without thrombus; therefore, anticoagulant therapy was discontinued. Currently, the patient has been well and active with a patent PV without anticoagulant therapy for 3 years after LDLT. Conclusions Retro-pancreatic pull-through reconstruction of the hypoplastic PV is a feasible and effective method when conventional reconstruction is not indicated.

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Living Donor Liver Transplantation for the Patients With Portal Vein Thrombosis: Use of an Interpositional Venous Graft Passed Posteriorly to the Pancreatic Parenchyma Without Using Jump Graft

Cited by 8 publications

References 12 publications

The friendly incidental portal vein thrombus in liver transplantation

The friendly incidental portal vein thrombus in liver transplantation

Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation

Retro-pancreatic pull-through reconstruction of the hypoplastic portal vein using the autologous mesosystemic shunt vessel in adult living donor liver transplantation: a case report

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