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P-12.25 Management of portal venous complications after liver transplant

Emre Karakaya, Turkey

Department of General Surgery
Baskent University


Management of portal venous complications after liver transplant

Emre Karakaya1, Aydincan Akdur1, Fatih Boyvat2, Feza Yarbug Karakayali1, Gokhan Moray1, Mehmet A. Haberal1.

1Transplantation, Baskent University, Ankara, Turkey; 2Interventional Radiology, Baskent University, Ankara, Turkey

Introduction: Although portal venous (PV) complications after liver transplantation (LT) are rare, they may result in graft loss. We evaluated PV complications after LT in our center.
Patients and Methods: PV anastomoses were performed end-to-end using 2-quadrant technique. One PV was anastomosed end-to-end to the collateral vein draining to the superior mesenteric vein. One patient had partial thrombus in the main PV before transplantation. After thrombectomy, anastomosis was performed. Post-operatively, intravenous heparin infusion and then oral anticoagulant agent was given to patients.
Results: A total of 649 LT were performed in our center between December 1988 and December 2019. PV complications developed in 18 of the patients. 12 (%66) were pediatric. Ten of these patients (%58.8) were CHILD C. The mean GRWR was 2.5% (0.66-4.5). The complications were 10 stenosis, 4 aneurysm, 2 thrombus, 1 thrombus with aneurysm and 1 thrombus with stenosis.  Four of the complications occurred in the first 3 months. These are one was aneurysm, two stenosis and one was thrombus. PV enlarged on average by 5 mm on aneurysms, did not require intervention. If the stenosis <50%, percutaneous transluminal angioplasty (PTA) was performed. Stent placement was performed on three patients with >50% stenosis. On the postoperative first day PV thrombus developed in one patient and treated with surgical thrombectomy. In the case of thrombus detected in later stages, portal venous flow was increased via endovascular interventions. Three patients were past away during follow up period due to pneumonia and sepsis.
Conclusion: High CHILD score, high GRWR and pediatric patients are the risk factors for the development of PV complication. Thrombectomy via laparotomy should be considered primarily in first ten days after LT. After this period if PV complication occurs, it can be treated with interventional radiological techniques successfully.


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