J Korean Surg Soc.  2011 Jul;81(1):35-42. 10.4174/jkss.2011.81.1.35.

An early single-center experience of portal vein thrombosis in living donor liver transplantation: clinical feature, management and outcome

• Kim JD
• Choi DL
• Han YS

• KMID: 1853529
• DOI: http://doi.org/10.4174/jkss.2011.81.1.35

Abstract

PURPOSE
Portal vein thrombosis (PVT) has been considered a relative contraindication for living donor liver transplantation (LDLT). However, it is no longer a contraindication of LDLT due to improvement in surgical techniques and approaches to PVT. The aim of this study was to assess the impact of PVT on outcomes in LDLT patients.
METHODS
We retrospectively analyzed the data from 97 adult patients undergoing LDLT in our center from July 2008 to June 2010. Intraoperative findings and preoperative imaging results were reviewed for PVT grading (Yerdel grading). We analyzed the technical aspects and comparisons of risk factors, perioperative variables, and survivals between patients with and without PVT based on the grades.
RESULTS
In the 97 LDLT patients, 18 patients were confirmed to have PVT (18.5%) including grade I cases (n = 8), grade II (n = 7), and grade III (n = 3). Prior treatment of portal hypertension was found to be an independent risk factor for PVT (P = 0.001). The comparisons between PVT and no PVT groups showed no significant difference in intraoperative and postoperative variables except for postoperative bleeding (P = 0.036). The short-term portal vein patency, in-hospital mortality and survival rates were not significantly different between the PVT and control groups.
CONCLUSION
The outcomes are similar to non-PVT group in terms of in-hospital mortality, survival rates, and postoperative complications. Therefore, our study suggests that PVT cannot be considered to be a contraindication for LDLT and LDLT could be undertaken without increased morbidity and mortality in patients with PVT, in spite of operative complexity.

Keyword

Portal vein; Thrombosis; Liver transplantation; Outcome assessment

MeSH Terms

Adult
Hemorrhage
Hospital Mortality
Humans
Hypertension, Portal
Liver
Liver Transplantation
Living Donors
Portal Vein
Postoperative Complications
Retrospective Studies
Risk Factors
Survival Rate
Thrombosis

Figure

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  Fig. 1 Survival curves in the portal vein thrombosis (PVT) and non-PVT groups (A), and in the PVT and non-PVT groups after excluding malignancy (B).

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  Fig. 2 Portal vein (PV) reconstruction with interposition vein graft in case of failed eversion thrombectomy. Preoperative computed tomography (CT) scan of this case showed that portal vein is completely obstructed (white arrow) and PV thrombosis propagated to portomesenteric junction (A). Interposition vein graft was used for portal vein reconstruction (B) and intraoperative PV stenting (black arrow) was performed due to residual thrombus (C). Patency of interposition graft was demonstrated by postoperative CT scan (D).

• 

  Fig. 3 Portal vein (PV) reconstruction with renoportal anastomosis. Abdominal computed tomography (CT) scan showed complete portal vein thrombosis extended to proximal superior mesenteric vein (arrow) and marked dilated splenorenal shunt drained into the left renal vein (arrow head) (A). Interposition graft was anastomosed to upper border of left renal vein and the graft PV is anastomosed to proximal end of the interposition graft (B). No signs of portal vein system stenosis were visible in postoperative abdominal CT scan (C).

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