Liver transplantation for portal vein thrombosis: Single center experience
Stepan Zubenko1, Artem Monakhov1, Olga Tsirulnikova2, Daria Umrik1, Sergey Gautier1,2.
1Surgical Department 2, Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation; 2I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Introduction: Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. The presence of portal thrombosis leads to the progression of portal hypertension and potentially complicate the liver transplantation. The most common classification (Yerdel) is based on the prevalence of thrombosis of the portal system (IV stages). For a long time, severe PVT (III-IV) was considered as a contraindication to liver transplantation due to the complexity of portal revascularisation. However, the current development of vascular surgery suggests a few effective surgical options for these patients.
Purpose: Analysis of deceased donor liver transplantation in patients with the presence of PVT.
Materials and Methods: The study included the period from January 2016 to February 2020. During this period at the National Medical Research Center of Transplantology and Artificial Organs were performed 241 deceased donor liver transplantation for adult patients. Of these, 25 recipients (10,3%) obtained PVT before transplantation. Fifteen patients had PVT stage I-II, ten patients had severe thrombosis of III and IV stage (six and four respectively). To revascularization of portal flow in the patients with local thrombosis, thrombectomy was performed in 15 cases, in 6 cases (with PVT III stage) an eversion thrombectomy technique was used to remove the thrombus. In four cases (PVT stage IV) were performed various techniques of portal flow bypass. One case was applied by rent portal transposition witch was supplemented by jump-graft between superior mesenteric vein (SMV) and graft’s portal vein (PV). In another case, just a jump-graft technique using donor IVC graft was applied. In two cases, portal supply was carried out from the varicose left gastric vein. When comparing with the control group (n = 216), there were no statistically significant differences in-hospital mortality rates or the length of hospital stay, however, in the group of patients with severe portal vein thrombosis (stages III-IV), early postoperative bleeding was more common.
Conclusions: Portal vein thrombosis, including severe thrombosis (Yardel III-IV stages) is not a contraindication for liver transplantation. In a high-volume centers, the presence of PVT is not impact on the results of transplantation.
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