Preoperative portal vein recanalization–transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation

Abstract

High-grade portal vein thrombosis (PVT) is often considered to be a technically challenging scenario for liver transplantation (LT) and in some centers a relative contraindication. This study compares patients with chronic obliterative PVT who underwent portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) and subsequent LT to those with partial nonocclusive PVT who underwent LT without an intervention. This institutional review board-approved study analyzed 49 patients with cirrhosis with PVT from 2000 to 2020 at our institution. Patients were divided into two groups, those that received PVR-TIPS due to anticipated surgical challenges from chronic obliterative PVT and those who did not because of partial PVT. Demographic data and long-term outcomes were compared. A total of 35 patients received PVR-TIPS while 14 did not, with all receiving LT. Patients with PVR-TIPS had a higher Yerdel score and frequency of cavernoma than those that did not. PVR-TIPS was effective in decreasing portosystemic gradient (16 down to 8 mm HG; p < 0.05). Both groups allowed for end-to-end anastomoses in >90% of cases. However, veno-veno bypass was used significantly more in patients who did not receive PVR-TIPS. Additionally, patients without PVR-TIPS required significantly more intraoperative red blood cells. Overall survival was not different between groups. PVR-TIPS demonstrated efficacy in resolving PVT and allowed for end-to-end portal vein anastomoses. PVR-TIPS is a viable treatment option for chronic obliterative PVT with or without cavernoma that simplifies the surgical aspects of LT.

Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS) Facilitates Liver Transplantation in Cirrhotic Patients with Occlusive Portal Vein Thrombosis

“…One group of 35 patients underwent PVR-TIPS for chronic obliterative PVT (high risk for LT), and the other group of 14 patients with partial, expansile PVT (low risk for LT) proceeded directly to transplant. 43 All patients received LT, and in the second group veno-veno bypass was required in a statistically significant greater number of cases (2 cases vs. 0 cases in the PVR-TIPS group). The second group also required significantly more intraoperative red blood cells.…”

Comparison of the efficacy and safety between rivaroxaban and dabigatran in the treatment of acute portal vein thrombosis in cirrhosis

“…Thrombocytopenia was defined as platelet count < 100 x /L [ 24 ]. The Yerdel grading system includes: grade 1, < 50% occlusion of main portal vein with no or minimal obstruction of superior mesenteric vein (SMV); grade 2, > 50% obstruction of main portal vein; grade 3, complete obstruction of main portal vein and proximal SMV; grade 4, complete obstruction of the portal vein and SMV [ 25 ]. All patient underwent endoscopic screening and primary prophylaxis for variceal bleeding according to the Baveno VII consensus guidelines [ 26 ].…”

Transjugular Intrahepatic Portosystemic Shunt in Chronic Portal Vein Thrombosis—From Routine Recommendations to Demanding Scenarios

“…Other studies reporting outcomes of TIPS in pretransplant patients have also been promising. In a retrospective analysis of 35 patients receiving TIPS for chronic obliterative PVT before LT, it was found that TIPS demonstrated efficacy in resolving PVT and simplified the surgical aspects of LT, allowing for end-to-end portal vein anastomoses [ 28 ]. Another analysis of 30 patients who underwent TIPS to maintain PV patency while being listed for LT showed that 24 patients (80%) had improvement and/or the resolution of PVT after TIPS placement, with 18 of these (75%) having a complete resolution [ 29 ].…”