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

Sambommatsu, Yuzuru; Shimata, Keita; Ibuki, Sho; Narita, Yuki; Isono, Kaori; Honda, Masaki; Irie, Tomoaki; Kadohisa, Mikiko; Kawabata, Seiichi; Yamamoto, Haruyasu; Sugawara, Yasuhiko; Ikeda, Osamu; Inomata, Yukihiro; Hibi, Taizo

doi:10.1002/lt.25977

Cited by 11 publications

(4 citation statements)

References 30 publications

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“…Pre-transplant PVT (odds ratio [OR] = 15.20; 95% CI 3.70-62.40; p < 0.001) was the only independent risk factor for portal vein stenosis, while male sex (OR = 5.57; 95% CI 1.71-18.20; p = 0.004), pre-transplant PVT (OR = 4.79; 95% CI 1.64-14.00; p = 0.004), and splenectomy (OR = 3.24; 95% CI 1.23-8.57; p = 0.018) were independent risk factors for PVT [572]. Early detection of vascular problems and a tailored approach according to the time of onset and deformity patterns of vascular complications are essential [572,573].…”

Section: Portal Vein and Hepatic Vein Complicationsmentioning

confidence: 96%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines. Keywords Living donor liver transplantation • Deceased donor liver transplantation • Multidisciplinary • GradeSpecial consideration: LDLT in ACLF In a study of 112 LDLT recipients with ACLF, defined by the APASL definition, post-LT outcomes were excellent (92.9% at 5 years) [69]. In a study on high-model end-stage liver disease (MELD) (score ≥ 30) LDLT recipients with ACLF (n = 190), defined by the World Congress of Gastroenterology [70], the 5-year survival rate was 72.1% [71]. In a study of 117 LDLT recipients who had ACLF, as defined by the EASL-CLIF definition, post-transplant survival after LDLT was 92.9%, 85.4%, and 75.6% at 1 year, while mortality rate without LT was 28.5%, 77.7%, and 93.4% at 90 days, for ACLF grades 1, 2, and 3, respectively [72]. These data indicate that LDLT can be a life-saving treatment option for patients with ACLF.LDLT differs significantly from DDLT, as the timing of LDLT can be determined by the transplant team. There are advantages and disadvantages of LDLT in the setting of ACLF. The benefit of LDLT in patients with ACLF is its ability to provide rapid transplantation to critically ill patients [73], without waiting for deceased donor allocation. The ideal time for LT can be selected by transplant team when willing living donor is available. If ideal time for LT can be selected in the dynamic course of ACLF, this may improve post-LT outcome. The disadvantages of LDLT include the need for healthy, willing liver donor, and the use of partial grafts for critically ill patients. A graft-to-recipient weight ratio (GRWR) is a factor associated with post-LT outcomes in LDLT [74]. The donor risk index is a factor associated with post-LT outcomes for patients with ACLF who received DDLT [66,75]. This indicates that DDLT, which uses whole liver grafts, might be a better compared to LDLT, which uses partial grafts, in ACLF. In addition, there are uncertainties regarding the criteria for living donor graft quality that is required for critically ill patients with ACLF. In studies that reported...

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Section: Portal Vein and Hepatic Vein Complicationsmentioning

confidence: 96%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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“…2 Sichuan University-University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, Chengdu, Sichuan, People's Republic of China. 3 Department of Applied Mechanics, Sichuan University. No, 24 South Section of First Ring Road,, Chengdu 610065, Sichuan Province, People's Republic of China.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…Portal vein thrombosis (PVT) is a common complication in patients with cirrhosis, and its prevalence in liver cirrhosis ranges from 2.1 to 16.2%, which is higher in patients waiting for liver transplantation, ranging from 5.5 to 26% [1]. Numerous studies have found that PVT is associated with worse outcomes for pre-and post-liver transplantation [2][3][4]. Moreover, PVT may exacerbate portal hypertension and contribute to portal hypertension-related variceal bleeding, thus could possibly increasing the risk for the development of acute decompensation [5].…”

Section: Introductionmentioning

confidence: 99%

A novel potential mechanism for the development of portal vein thrombosis in cirrhosis based on portal hemodynamics

et al. 2022

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Background Marked changes in hemodynamics have been suggested to be a potential contributing factor to portal vein thrombosis (PVT) development. This study investigated the effect of portal hemodynamics based on the anatomical structure of the portal venous system on PVT development. Methods The morphological features of portal venous system in patients with PVT and those without PVT subgroups were compared. In addition, idealized PV models were established to numerically evaluate the effect of the variation in the angulation of superior mesenteric vein (SMV) and splenic vein (SV) on the hemodynamics of portal venous system. Results The angle α (angulation of SMV and SV) in patients with PVT was lower than that in patients without PVT (p < 0.0001), which was the only independent risk factor (odds ratio (OR), 0.90 (95% CI 0.84–0.95); p < 0.0001) for the presence of PVT. With the change in angle α, the flow pattern of blood flow changed greatly, especially the helical flow. When α = 80°, helical flow only appeared at the local PV near the intersection of SMV and SV. When α = 120°, most regions were occupied by the helical flow. In addition, the h2 gradually increased with increasing α, when α = 80°, h2 = 12.6 m/s2; when α = 120°, h2 = 29.3 m/s2. Conclusions The angulation of SV and SMV was closely associated with PVT development. Helical flow changed following the varying angulation of SV and SMV. Therefore, angulation of SV and SMV may help to identify high-risk cohorts for future PVT development earlier.

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“…This mini review was intended to provide a snapshot of the current status of nontransplant management for portomesenteric thrombosis (PMT). PMT is a well-known and long-standing complication of cirrhosis and has been extensively described particularly in the setting of liver transplantation [1][2][3][4]. More recently, PMT has been gaining attention as a serious complication of bariatric surgery in the era of global obesity epidemic [5][6][7], which might result in small bowel or liver transplantation in the worstcase scenario [8,9].…”

Section: Introductionmentioning

confidence: 99%

Nontransplant options for portomesenteric thrombosis

Hibi

2022

Current Opinion in Organ Transplantation

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Purpose of reviewPortomesenteric thrombosis (PMT) is a serious condition encountered mainly in cirrhotic patients awaiting liver transplantation. More recently, this potentially fatal complication has been described after bariatric surgery and inflammatory bowel disease. Several consensus guidelines have been published over the past few years and this mini review was conducted to discuss updated nontransplant treatment options based on currently available evidence.Recent findingsAnticoagulation is the mainstay of treatment for PMT involving <50% of the main portal vein. Transjugular intrahepatic portosystemic shunt are usually preserved for patients with more extensive disease or those with clinically significant portal hypertension that are treatment refractory.SummaryThe extent of PMT, response to therapy, and complications related with PMT are the determinants of therapy.

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

Cited by 11 publications

References 30 publications

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

A novel potential mechanism for the development of portal vein thrombosis in cirrhosis based on portal hemodynamics

Nontransplant options for portomesenteric thrombosis

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