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

Mori, Akira; Iida, Takuya; Iwasaki, Junji; Ogawa, Kohei; Fujimoto, Yasuhiro; Uemura, Tadahiro; Hatano, Etsuro; Okajima, Hideaki; Kaido, Toshimi; Üemoto, Shinji

doi:10.1002/jhbp.235

Cited by 32 publications

(36 citation statements)

References 29 publications

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“…Precise imaging evaluations of PVT before LT is necessary to plan for PV reconstruction, and conventional end‐to‐end portal anastomosis should always be the first‐line option. The management of adult living donor liver transplantation (LDLT) is principally similar to deceased donor liver transplantation (DDLT), but LDLT in patients with PVT has its own difficulties, such as the need for distal dissection of the vascular pedicle of the hilum and restricted availability of a vein graft . Technical issues have been extensively reviewed previously, and the algorithm for the management of PVT during LT has been proposed according to Yerdel classification …”

Section: Impact Of Portal Vein Thrombosis In Liver Transplantation Prmentioning

confidence: 99%

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Chen¹,

Turón²,

et al. 2016

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Portal vein thrombosis (PVT) occurs in approximately 2%-26% of the patients awaiting liver transplantation (LT) and is no longer an absolute contraindication for LT. Nearly half of PVT cases are accidentally found during the LT procedure. The most important risk factor for PVT development in cirrhosis may be the severity of liver disease and reduced portal blood flow. Whether other inherited or acquired coagulation disorders also play a role is not yet clear. The development of PVT may have no effect on the liver disease progression, especially when it is nonocclusive. PVT may not increase the risk of wait-list mortality, but it is a risk factor for poor early post-LT mortality. Anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) are 2 major treatment strategies for patients with PVT on the waiting list. The complete recanalization rate after anticoagulation is approximately 40%. The role of TIPS to maintain PV patency for LT as the primary indication has been reported, but the safety and efficacy should be further evaluated. PVT extension and degree may determine the surgical technique to be used during LT. If a "conventional" end-to-end portal anastomotic technique is used, there is not a major impact on post-LT survival. Post-LT PVT can significantly reduce both graft and patient survival after LT and can preclude future options for re-LT. Liver Transpl 22:352-365, 2016. V C 2015 AASLD.

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Section: Impact Of Portal Vein Thrombosis In Liver Transplantation Prmentioning

confidence: 99%

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Chen¹,

Turón²,

et al. 2016

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“…The main advantage of these direct techniques is complete clearance of the PVT under direct inspection, whereas the disadvantage is huge amounts of bleeding due to vigorous collateral vessels with portal hypertension. Most LT surgeons recommend renoportal anastomosis in patients with SR shunt and shunt‐PV anastomosis in patients with prominent perihepatic or left gastric shunts . These detour approaches have a lower risk of uncontrollable bleeding but might have unstable inflow associated with detour flow with steals into shunts or with compression or kinking of the interposition grafts …”

Section: Discussionmentioning

confidence: 99%

“…Yerdel et al categorized the severity of PVT in LT into 4 grades: grade 1, PVT <50% of the portal vein (PV) lumen; grade 2, PVT >50% of the PV lumen; grade 3, PVT with proximal superior mesenteric vein (SMV) thrombosis; and grade 4, entire SMV thrombosis. To date, PV thrombectomy has been recommended for grade 1 and 2 PVT; nonanatomical jump grafts have been recommended for grade 3 PVT; and cavo‐PV anastomosis or no indication of LT has been recommended for grade 4 PVT . For advanced PVT, thrombectomy has not been recommended because of the risk of severe bleeding; instead, nonanatomical reconstruction including renoportal anastomosis, shunt‐PV anastomosis, and the use of a jump graft from the SMV have been performed.…”

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confidence: 99%

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

et al. 2019

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Management of portal vein thrombosis (PVT), especially advanced PVT involving the superior mesenteric vein (SMV), in living donor liver transplantation (LDLT) is challenging. There were 514 adults who underwent LDLT between 2005 and 2018 included in this retrospective study, and PVT was observed in 67 (13.0%) patients. The LDLT recipients with PVT were characterized by increased portal pressure at laparotomy (26.1 ± 6.0 versus 24.3 ± 5.9 mm Hg; P = 0.03) and at closure (16.8 ± 3.9 versus 15.6 ± 3.6 mm Hg; P = 0.02), increased operative blood loss (14.6 ± 29.7 versus 5.7 ± 6.3 L; P < 0.01), and decreased 1‐year graft survival (83.5% versus 92.8%; P = 0.04). Among the 18 patients with atrophic or vanished portal vein on pre‐LDLT computed tomography, significant portal atrophy was actually observed only in 1 (5.6%) patient during LDLT surgery. For advanced PVT (n = 7) involving SMV in era 1, we performed nonanatomical inflow reconstruction using interposition grafts, resulting in significant inflow problems in 4 (57.1%) patients. Thus, for the patients with advanced PVT (n = 4) in era 2, we abandoned nonanatomical reconstruction and applied extensive thrombectomy under ultrasound guidance with secure shunt ligation, resulting in no inflow problems and no graft loss. In conclusion, even for advanced PVT involving SMV, extensive thrombectomy under sonogram guidance followed by anatomical inflow reconstruction and shunt ligation is a legitimate strategy in adult LDLT with PVT.

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“…VTE: Forty-eight (17%) of the 282 consecutive adult LDLTs recipients between April 2006 and December 2011 had pre-existing portal vein thrombosis (PVT) [59]. Although a fatal outcome occurred in a severe PVT patient who received an LDLT [60], excellent survival rates were reported in patients with PVT who underwent LDLT [59].…”

Section: Activation and Consumption Of Platelets Due To Thrombosismentioning

confidence: 99%

“…Although a fatal outcome occurred in a severe PVT patient who received an LDLT [60], excellent survival rates were reported in patients with PVT who underwent LDLT [59]. In another study, 68 (2.9%) of 2402 patients who underwent LDLT had PVT and those patients with PVT were found to have a worse prognosis than those without PVT [61].…”

Section: Activation and Consumption Of Platelets Due To Thrombosismentioning

confidence: 99%

Platelets Activation and Liver Transplantation

Usui¹,

Wada²,

Mizuno³

et al. 2017

J Liver

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Transient thrombocytopenia is a common phenomenon after living donor liver transplantation (LDLT), and severe thrombocytopenia after LDLT is associated with graft loss and poor patient outcomes. The various causes of thrombocytopenia include bone marrow hematopoiesis failure due to decreased thrombopoietin (TPO) production in the injured liver, platelet destruction associated with splenomegaly, and the activation and consumption of platelets due to various forms of thrombosis, including disseminated intravascular coagulation (DIC), thrombotic microangiopathy (TMA), and venous thromboembolism (VTE).The observation of biomarkers such as soluble platelet glycoprotein VI (sGPVI), TPO, von Willebrand factor (VWF), VWF propeptide (VWFpp), and disintegrin-like and metalloproteinase with thrombospondin type-1 motifs member 13 (ADAMTS13) is useful in the evaluation of the mechanisms of thrombocytopenia in patients who undergo LDLT. The presence of these biomarkers, including sGPVI, ADAMTS13, VWF and VWFpp, suggests that platelet activation occurs in the early phase of LDLT and that vascular endothelial cell injury occurs on postoperative days 7-14.

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

Abstract: The excellent survival rates in patients with PVT who underwent LDLT could be attributed to our strategies, which included surgical techniques and timely treatment of postoperative complications.

Cited by 32 publications

References 29 publications

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

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

Platelets Activation and Liver Transplantation

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