Abstract
Background
Liver transplantation in the setting of portal vein thrombosis is an intricate issue
that occasionally necessitates extraordinary procedures for portal flow restoration.
However, to date, there is no consensus on a persistent management strategy, particularly
with extensive forms. This work aims to introduce our experience-based surgical management
algorithm for portal vein thrombosis during liver transplantation and to clarify some
of the debatable circumstances associated with this problematic issue.
Methods
Between 2006 and 2019, 494 adults underwent liver transplantation at our institute.
Ninety patients had preoperative portal vein thrombosis, and 79 patients underwent
living donor liver transplantation. Our algorithm trichotomized the management plan
into 3 pathways based on portal vein thrombosis grade. The surgical procedures implemented
included thrombectomy, interposition vein grafts, jump grafts from the superior mesenteric
vein, jump grafts from a collateral and renoportal anastomosis in 56, 13, 11, 4, and
2 patients, respectively. Four patients with mural thrombi did not require any special
intervention.
Results
Thirteen patients experienced posttransplant portal vein complications. They all proved
to have a patent portal vein by the end of follow-up regardless of the management
modality. No significant survival difference was observed between cohorts with versus
without portal vein thrombosis. The early graft loss rate was significantly higher
with advanced grades (P = .048) as well as technically demanding procedures (P = .032).
Conclusion
A stepwise broad-minded strategy should always be adopted when approaching advanced
portal vein thrombosis during liver transplantation. An industrious preoperative evaluation
should always be carried out to locate the ideal reliable source for portal flow restoration.
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Article info
Publication history
Published online: August 26, 2020
Accepted:
July 20,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
