Thrombendvenectomy for Organized Portal Vein Thrombosis at the Time of Liver Transplantation

Molmenti, Ernesto P.; Roodhouse, Thomas W.; Molmenti, Hebe; Jaiswal, Kshama; Jung, Ghap Joong; Marubashi, Shigeru; Sanchez, Edmund Q.; Gogel, Brian M.; Levy, Marlon F.; Goldstein, Robert M.; Fasola, Carlos G.; Elliott, Eric E.; Bursac, Nevenka; Mulligan, David C.; Gonwa, Thomas A.; Klintmalm, Göran B.

doi:10.1097/00000658-200202000-00019

Cited by 131 publications

(115 citation statements)

References 12 publications

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“…At the time of listing patients for transplantation at our center, routine pre-operative review of all imaging is performed to prepare for intra-operative and anatomic challenges. Our findings are supported by other series that have demonstrated excellent outcomes with operative thrombectomy in patients with preop PVT [20,21].…”

Section: Discussionsupporting

confidence: 90%

“…Hepatocellular carcinoma (HCC) was found in 108 patients (30.9%). The complete distribution of the etiology of end stage liver disease (ESLD) is as follows: HCV alone 17.4% (61), ETOH/HCV 16.6% (58), HCV/HCC 14.3% (50), PSC 10.6% (37), ETOH alone 6.9% (24), ETOH/HCV/HCC 6.6% (23), HBV related 5.1% (18), PBC 4.9% (17), NASH 3.4% (12), ETOH/HCC 3.1% (11), Autoimmune hepatitis 2.9% (10), Cryptogenic cirrhosis 2.6% (9), other 5.7% (20).…”

Section: Resultsmentioning

confidence: 99%

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Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?

Enestvedt¹,

Enestvedt²,

Diggs³

et al. 2011

OJOTS

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Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more postoperative thrombotic events than those without PVT. Aims: To compare rates of post-op thrombotic events and outcomes between those with and without pre-op PVT. Methods: All OLT recipients between 1/02-4/09 were retrospectively reviewed. Outcome measures included survival, deep venous thrombosis, pulmonary embolism, hepatic artery thrombosis, and recurrent PVT. Minimum follow up was 6 months. Results: In 363 OLTs performed, mean recipient age was 53.1 yrs (±9.2); 268 patients were male. Mean MELD at transplant was 22.1 (±6.2). The prevalence of pre-op PVT was 11.2% (41/350). There was no difference in the % of post-op thrombotic events between those with and without PVT (p = 0.77). MELD, recipient and donor age, and gender were similar in both groups. Mean survival in those with pre-op PVT was 85.2 months vs. 78.7 in those without PVT (p = 0.19). Conclusions: The rate of post-op thrombotic events was equivalent in OLT recipients with and without pre-op PVT. The presence of PVT did not adversely impact patient survival and should not be a contraindication to OLT.

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?

Enestvedt¹,

Enestvedt²,

Diggs³

et al. 2011

OJOTS

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“…Surgical innovations have been reported for hilum dissection, thrombectomy and portal vein reconstruction using vein grafts in deceased liver transplantation. [1][2][3][4][5][6][7][8][9][10][11][12][13] In living donor liver transplantation (LDLT), there are technical difficulties due to these challenges for preexisting PVT patients; necessity of distal dissection of vascular pedicle of the hilum and restricted availability of a vein graft. The presence of PVT in the recipient has frequently been presented as a relative or absolute contraindication in LDLT by numerous groups.…”

Section: See Editorial On Page 1455mentioning

confidence: 99%

Single center experience of 39 patients with preoperative portal vein thrombosis among 404 adult living donor liver transplantations

et al. 2006

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Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) involves technical difficulty. The aim of this research was to analyze their preoperative diagnosis of PVT, operative procedures, and postoperative courses of patients with preoperative PVT. Thirty-nine patients of 404 adult patients (9.7%) undergoing LDLT in our hospital from 1996 June to 2004 December had PVT at their transplantation. Twenty-nine patients had intractable ascites, 21 had gastrointestinal bleeding, and 18 had encephalopathy. The thrombus was located in the portal trunk in 23, in the portal trunk and superior mesenteric vein (SMV) in 7, and developed into the SMV and the splenic vein in 8. The occlusive grade was partial in 29, and complete in 10 patients. The thrombus was removed by a simple technique, and eversion and/or incision technique, or total removal of the portal vein (PV). The PV was reconstructed with the thrombectomized native PV, with an interposed vein graft, or porto-caval hemitransposition. Advanced PVT had a significant impact on blood loss and hospital mortality. Three out of 10 patients with residual PVT required radiological and/or surgical intervention after transplantation. In conclusion, thorough planning is essential for a successful LDLT outcome for patients with preexisting PVT. Liver Transpl 12:1512-1518, 2006

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“…[4][5][6][7][8] Now, patients with PVT may be transplanted, but the level of difficulty for the surgeon is increased as are the number of postoperative complications. [9][10][11][12][13] Studies have shown that transjugular intrahepatic shunt (TIPS) is technically feasible in patients with PVT, but the studies include a wide range of patients with malignancy, hypercoagulable states, and pancreatitis as the cause of PVT. 14,15 In cirrhotics, TIPS have been placed successfully in patients with portal vein clot for the standard indication of ascites and hemorrhage.…”

mentioning

confidence: 99%

The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis

et al. 2006

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The purpose of this research was to study the efficacy and outcomes of transjugular intrahepatic shunt (TIPS) in end-stage liver disease (ESLD) patients with portal vein thrombosis (PVT) eligible for orthotopic liver transplant. Nine consecutive patients with PVT underwent TIPS as a nonemergent elective outpatient procedure. The primary indication for TIPS was to maintain portal vein patency for optimal surgical outcome. Eight patients underwent contrast enhanced computed tomography (CT) and 1 magnetic resonance imaging diagnosing PVT. Shunt creation was determined by available targets at the time of TIPS and by prior imaging. Patients were followed with portography, ultrasound, CT, or magnetic resonance imaging, and the luminal occlusion was estimated before and after TIPS. Primary endpoints were transplantation, removal from the transplant list, or death. Stabilization, improvement, or complete resolution of thrombosis was considered successful therapy. Failures included propagation of thrombosis or vessel occlusion, and poor surgical anatomy due to PVT. Of 9 patients with PVT, TIPS was successfully placed in all patients without complication or TIPS-related mortality. Eight of 9 patients (88.8%) had improvement at follow-up. One patient failed therapy and re-thrombosed. Two patients (22.2%) were transplanted without complication and had no PVT at the time of transplant. Eight of 9 patients were listed for transplant at the time of their TIPS. Eight of 9 PVTs were nonocclusive. Four of 9 patients (44%) had evidence of cavernous transformation. Two patients expired during follow-up 42 and 44 months after TIPS. Three patients remain on the transplant list. One patient has not been listed due to nonprogression of disease. One patient has been removed from the transplant list because of comorbid disease. In conclusion, TIPS is safe and effective in patients with PVT and ESLD requiring transplant. Patients can be successfully transplanted with optimal surgical anatomy. Liver Transpl 12: 1544-1551, 2006.

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Thrombendvenectomy for Organized Portal Vein Thrombosis at the Time of Liver Transplantation

Cited by 131 publications

References 12 publications

Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?

Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?

Single center experience of 39 patients with preoperative portal vein thrombosis among 404 adult living donor liver transplantations

The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis

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