Clinical Outcome of Preoperative Portal Vein Thrombosis in Living Donor Liver Transplantation

Kim, Say June; Moon, In Sung; Lee, Myung Duk; Kim, Dong Goo

Abstract

PURPOSE: Portal vein thrombosis (PVT), which once had been considered a relative contraindication for living donor liver transplantation (LDLT), is no longer contraindication of LDLT owing to technical achievement but could be remained as one of risk factor affecting patients. The aim of the present study was to improving outcomes of LDLT of patients with PVT by analyzing patients with PVT.
METHODS
Between January 2000 and May 2006, 246 cases of LDLT in adult using right lobe were performed. The presence of PVT was preoperatively evaluated by CT and/or MR angiography. The patients were subdivided according to presence and characteristics of PVT; No PVT (n=196; 79.7%), Partial PVT (n=39; 15.9%) and Total PVT (n=11; 4.4%) and characteristics of each group were analyzed.
RESULTS
Preoperatively, only the incidence of variceal bleeding was significantly higher in patients with PVT (P<05). Intraoperatively, larger amounts of transfused RBC were needed in PVT group and postoperatively, there were prolonged stay in ICU and higher incidence of hemorrhagic complications in PVT group. Portal inflow was reestablished by thrombectomy and end-to-end anastomosis without vessel graft in 97.4%(38/39) of partial PVT and in 54.5%(6/11) of total PVT. Cryopreserved veins were used as interposition (n=1) or jump (n=4) grafts and an autologous iliac vein was used as a jump graft (n=1). Of 5 cases of jump grafts, 2 cases were anastomosed to coronary vein, and 3 cases to superior mesenteric vein. The patency rate using vessel grafts was 83.3%(5/6) and overall patency rate including thrombectomy cases was 98.0%(39/40).
CONCLUSION
Regardless of operative methods and materials, higher patency rate of portal vein could be achieved so that operation of patients with PVT could be undertaken safely without increased mortality.