Usefulness of Artificial Jump Graft to Portal Vein Thrombosis in Deceased Donor Liver Transplantation

Abstract

Severe portal vein thrombosis (PVT) is often considered a relative contraindication for living donor liver transplantation due to high associated risks and morbidity. Meanwhile, improvement in operative techniques, resulting in higher success rates has removed PVT from the list of contraindications in deceased donor liver transplantation (DDLT). In this report, we describe a surgical technique for DDLT using polytetrafluoroethylene graft from the inferior mesenteric vein for portal inflow in patient with portomesenteric thrombosis.

Nontumoral portal vein thrombosis in patients awaiting liver transplantation

“…If portal flow is insufficient, different options can be considered in order to establish an adequate portal flow, like ligation of the portosystemic collaterals or the left renal vein if splenorenal shunt (SRS) exists, additional PV arterialization, or an additional interposition graft between a patent splanchnic tributary and the PV . If an adequate flow cannot be achieved or a low dissection of the retropancreatic PV or distal SMV part is required, a jump graft or polytetrafluoroethylene graft from the SMV to the donor PV will be necessary . In grade IV patients, the PV can be anastomosed to a patent splanchnic tributary, for example, the coronary vein or a large collateral vein (diameter of 2 cm or more) .…”

“…81 If an adequate flow cannot be achieved or a low dissection of the retropancreatic PV or distal SMV part is required, a jump graft or polytetrafluoroethylene graft from the SMV to the donor PV will be necessary. 81,82,84 In grade IV patients, the PV can be anastomosed to a patent splanchnic tributary, for example, the coronary vein or a large collateral vein (diameter of 2 cm or more). 4,82,[85][86][87] If the portal inflow after these methods was suboptimal or PV cannot be anastomosed, PV arterialization is a simple and effective method of augmenting suboptimal portal inflow in endto-end or end-to-side anastomosis.…”

Liver transplant in patients with portal vein thrombosis: Medical and surgical requirements

“…Choice of graft material includes donor iliac vein, recipient internal jugular vein, cryopreserved vein, or synthetic graft (eg, polytetrafluoroethylene [PTFE]). Although artificial conduits have been used, the longterm patency of synthetic grafts has not been reported and there is concern for increased risk of thrombosis due to low venous flow rates compared with use in arterial grafting . Systemic venous inflow should be considered when mesenteric veins are thrombosed.…”

“…Although artificial conduits have been used, the longterm patency of synthetic grafts has not been reported and there is concern for increased risk of thrombosis due to low venous flow rates compared with use in arterial grafting. (16) Systemic venous inflow should be considered when mesenteric veins are thrombosed. Cavoportal hemitransposition, renoportal anastomosis (especially in the setting of significant mesenteric shunting to left renal vein), pericholedochal varix, and an enlarged coronary vein offer potential options for venous inflow to the allograft.…”

Portal vein thrombosis during liver transplantation: The risk of extra‐anatomical portal vein reconstruction

“…PVT itself is now no longer an absolute contraindication and there have been several published studies on LT in patients with PVT . However, the extent of PVT can be highly variable and evidence on the feasibility and safety of LT in severe portomesenteric thrombosis extending to the deep portion of superior mesenteric vein (SMV) is still scarce, with most of the published studies reporting only short‐term outcome of their successful case reports . While only the study by Hibi et al included a sufficient amount of cases with extra‐anatomical portal vein reconstruction in severe thrombosis extending to the deep portion of SMV, other studies only included small numbers of cases and made exaggerated conclusions that LT in patients with PVT is feasible and difficult cases can be overcome by jump graft formation .…”