Outcome and Hepatic Hemodynamics in Liver Transplant Patients with Portal Vein Arterialization

Charco, R.; Margarit, C; López-Talavera, Juan Carlos; Hidalgo, Ernest; Castells, L.; Allende, Helena; Segarra, Antoni; Moreiras, M.; Bilbao, Itxarone

doi:10.1034/j.1600-6143.2001.001002146.x

Cited by 23 publications

(45 citation statements)

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“…Arterialization may be performed using the recipient's hepatic artery through a side-to-side anastomosis, an iliac graft between the aorta and the portal vein or an arterial branch of the coeliac axis [56,57]. Only case reports or small series have been published, showing that calibrated arterialization may help restore portal flow without overt portal hypertension.…”

Section: Patients With Partial Portal Vein Thrombosismentioning

confidence: 99%

Portal vein thrombosis, cirrhosis, and liver transplantation

Francoz

Valla

Durand

2012

Journal of Hepatology

224

265

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Section: Patients With Partial Portal Vein Thrombosismentioning

confidence: 99%

Portal vein thrombosis, cirrhosis, and liver transplantation

Francoz

Valla

Durand

2012

Journal of Hepatology

224

265

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“…Various alternatives have been reported to overcome PVT, including cavoportal hemitransposition (CPHT), renoportal anastomosis (RPA), and portal arterialization. 3,4,7 Other authors have reported combined liver-intestinal transplantation with a 3-year survival rate around 60%. 2 In our case, we decided to perform an end-to-end portal anastomosis to the confluence of 2 thinwalled paracholedochal collateral veins, which provided adequate early portal inflow (800 mL/min).…”

Section: Discussionmentioning

confidence: 99%

Portal Revascularization in the Setting of Cavernous Transformation Through a Paracholedocal Vein: A Case Report

Rotellar

Cienfuegos

Bueno

et al. 2010

Transplantation Proceedings

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Diffuse thrombosis of the entire portal system (PVT) and cavernomatous transformation of the portal vein (CTPV) represents a demanding challenge in liver transplantation. We present the case of a patient with nodular regenerative hyperplasia and recurrent episodes of type B hepatic encephalopathy concomitant with PVT as well as CTPV, successfully treated with orthotopic liver transplantation. The portal inflow to the graft was carried out through the confluence of 2 thin paracholedochal varicose veins, obtaining good early graft function and recovery of the encephalopatic episodes. This alternative should be kept in mind as an option to assure hepatopetal splanchnic flow in those cases of diffuse thrombosis and cavernomatous transformation of portal vein.H T E COMPLICATIONS of diffuse portal-splenic and superior mesenteric vein thrombosis (PVT) with subsequent cavernous transformation of the portal vein (CTPV) in noncirrhotic patients represent a clinical challenge. When the medical and interventional procedures fail, liver transplantation (OLT) or combined liver-small bowel transplantation remain the ultimate option.1,2 Although several surgical alternatives have been described to overcome PVT and CTPV in clinical series, the absence of portal flow remains a challenge in OLT, for it increases the morbidity and mortality of the procedure.3,4 Herein we have presented a case of a successful OLT in a patient with PVT and CTPV. The portal inflow of the graft was achieved through the confluence of two pericholedochal veins (Petren's veins). CASE REPORTA 54-year-old man with complete thrombosis of the portal vein and nodular regenerative hyperplasia (NRH) was referred for a transjugular intrahepatic portosystemic shunt (TIPS) procedure. The diagnosis of PVT due to antiphospholipid antibody syndrome had been previously established during 2 episodes of abdominal pain. Doppler ultrasound and computed tomography confirmed the PVT diagnosis. The patient later developed esophageal varices and bled on 3 ocasions despite /3-blocker administration, requiring sclerotherapy sessions.Six months after the TIPS procedure, he suffered several episodes of portosystemic encephalopathy (PSE). The patient was treated with conservative medical therapy, administration of lactulose nonabsorbable antibiotics, and a low-protein diet. However, the encephalopathy symptoms persisted, and he underwent an endovascular shunt reduction without clinical improvement.5 OLT was indicated due to the progressively debilitating PSE.

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“…The technique of PVA has been re-activated for liver transplantation [2,4,5,34,35]. The basis for the present study was our own experience with PVA during clinical liver transplantation and arterialisation of the liver in the pig and rat model [4,6,27].…”

Section: Discussionmentioning

confidence: 99%

Arterialisation of the portal vein as a model for the induction of hepatic fibrosis: description of microsurgical models in the rat

Müller

Brummer²,

Erhardt³

et al. 2005

Transpl Int

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Within the framework of liver transplantation, arterialisation of the portal vein in the case of non-recanalisable thrombosis has been reactivated. However, one of the consequences of this vascular reconstruction is the development of hepatic fibrosis. Clinical experience has shown that the development of fibrosis can be avoided by reducing portal inflow. We present, as a model for the induction of hepatic fibrosis, techniques of PVA, including transplantation. For PVA, several different techniques were used: the first with reduction of the portal inflow over a stent inserted in the right renal artery (PVA-B), the second with unrestricted flow using an aortic-portal segment (PVA-APS). The third technique was orthotopic liver transplantation with unrestricted portal arterialisation (OLTx-APS). Portal blood flow was measured with an ultrasonic flow probe. To determine the degree of hepatic fibrosis the amount of hydroxyproline was measured. Quantification of relative transcript levels of procollagen I was effected with real-time PCR using the TaqMan technology on a lightcycler instrument. The extracellular matrix was visualised with picro-sirius staining. Measurements with the ultrasonic probe showed a significant increase in flow rates, both with reduced (PVA-B) and unrestricted inflow (PVA-APS; OLTx-APS). The lowest survival rate (58%) was found in the group with unrestricted portal inflow. The reason for this was a high rate of thrombosis in the in the portal vascular tree (4 out of 12). In the OLTx-APS group four animals died within the first 3 postoperative days (69%), as a result of protracted postoperative shock. The overall survival rate was the highest (85%) in the group undergoing PVA with reduction of the portal inflow. PVA with unrestricted inflow was followed by a significant increase in extracellular collagen, which showed a clear correlation with the increase in the amount of hydroxyproline, the level of the mRNA for procollagen I and picro-sirius staining. With the operative PVA techniques presented herein, different arterial flow rates in the portal vein can be investigated. In our opinion these techniques represent an excellent animal model for studying the genesis of fibrosis and antifibrotic substances. By regulating the blood flow in the arterialised portal vein hepatic fibrosis can be reduced or even avoided. After a brief period of learning the microsurgical techniques, the surgeon can limit clamping times and achieve good results with these techniques.

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Outcome and Hepatic Hemodynamics in Liver Transplant Patients with Portal Vein Arterialization

Abstract: Liver transplantation with portal vein arterialization is an acceptable salvage alternative when insufficient portal venous flow to the graft is present. The double arterial supply does not imply changes in hepatic hemodynamics, at least in the early months post-transplant.

Cited by 23 publications

References 0 publications

Portal vein thrombosis, cirrhosis, and liver transplantation

Portal vein thrombosis, cirrhosis, and liver transplantation

Portal Revascularization in the Setting of Cavernous Transformation Through a Paracholedocal Vein: A Case Report

Arterialisation of the portal vein as a model for the induction of hepatic fibrosis: description of microsurgical models in the rat

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