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Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis

Vianna, Rodrigo M. MD*,†; Mangus, Richard S. MD*; Kubal, Chandrashekhar MD*; Fridell, Jonathan A. MD*; Beduschi, Thiago MD*; Tector, A. Joseph MD, PhD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e31825429c0
Original Articles
Abstract

Objective: To evaluate the clinical outcomes of multivisceral transplantation (MVT) in the setting of diffuse thrombosis of the portomesenteric venous system.

Background: Liver transplantation (LT) in the face of cirrhosis and diffuse portomesenteric thrombosis (PMT) is controversial and contraindicated in many transplant centers. LT using alternative techniques such as portocaval hemitransposition fails to eliminate complications of portal hypertension. MVT replaces the liver and the thrombosed portomesenteric system.

Methods: A database of intestinal transplant patients was maintained with prospective analysis of outcomes. The diagnosis of diffuse PMT was established with dual-phase abdominal computed tomography or magnetic resonance imaging with venous reconstruction.

Results: Twenty-five patients with grade IV PMT received 25 MVT. Eleven patients underwent simultaneous cadaveric kidney transplantation. Biopsy-proven acute cellular rejection was noted in 5 recipients, which was treated successfully. With a median follow-up of 2.8 years, patient and graft survival were 80%, 72%, and 72% at 1, 3, and 5 years, respectively. To date, all survivors have good graft function without any signs of residual/recurrent features of portal hypertension.

Conclusions: MVT can be considered as an option for the treatment of patients with diffuse PMT. MVT is the only procedure that completely reverses portal hypertension and addresses the primary disease while achieving superior survival results in comparison to the alternative options.

In Brief

Liver transplantation in the face of complete portomesenteric thrombosis is controversial with inferior outcomes when compared to patients with a patent portal venous system. In the present study, we describe the outcomes of 25 patients, in which a multivisceral transplant was performed in the setting of complete portomesenteric thrombosis.

Author Information

*Department of Surgery, Division of Transplantation, Indiana University School of Medicine, Indianapolis, IN;

Laboratory of Experimental Surgery, LIM-37, Division of Transplantation and Liver Surgery, University of Sao Paulo School of Medicine, Brazil.

Reprints: Rodrigo M. Vianna, MD, Department of Surgery, Indiana University School of Medicine, 550 N University BLVD, UH 4601, Indianapolis, IN 46202. E-mail: rvianna@iupui.edu.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.