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When and Why Portal Vein Thrombosis Matters in Liver Transplantation: A Critical Audit of 174 Cases

Hibi, Taizo MD, PhD*,†; Nishida, Seigo MD, PhD*,†; Levi, David M. MD§; Selvaggi, Gennaro MD*,†; Tekin, Akin MD*,†; Fan, Ji MD*,†; Ruiz, Phillip MD, PhD*,‡; Tzakis, Andreas G. MD, PhD

Annals of Surgery:
doi: 10.1097/SLA.0000000000000252
Original Articles
Abstract

Objective: To identify complications associated with different techniques utilized to treat portal vein thrombosis (PVT) during primary liver transplantation and their impact on survival.

Background: PVT remains an intricate problem in liver transplantation, and the long-term outcomes of patients with PVT who undergo transplantation are not well defined.

Methods: We performed a retrospective cohort analysis of all consecutive adult patients who underwent primary isolated liver transplantation from 1998 to 2009 (median follow-up period, 89 months). The outcomes of patients with PVT were compared with those without PVT.

Results: Among 1379 recipients, 174 (12.6%) had PVT at the time of transplantation [83 (48%) complete and 91 (52%) partial]. Among PVT patients with reestablished physiological portal inflow (PVT: physiological group; n = 149), 123 underwent thrombectomies, 16 received interpositional vein grafts, and 10 received mesoportal jump grafts. In 25 patients, physiological portomesenteric venous circulation was not reconstituted (PVT: nonphysiological group; 18 underwent cavoportal hemitranspositions, 6 renoportal anastomoses, and 1 arterialization). The PVT: nonphysiological group suffered a significantly increased incidence of rethrombosis of the portomesenteric veins and gastrointestinal bleeding, with a marginal 10-year overall survival rate of 42% (no PVT, 61%; P = 0.002 and PVT: physiological, 55%; P = 0.043). The PVT: physiological and no PVT groups exhibited comparable survival rates (P = 0.13). No significant differences in survival were observed between complete and partial PVT as long as physiological portal flow was reestablished.

Conclusions: The subset of PVT patients requiring nonphysiological portal vein reconstruction was associated with higher complication rates and suffered diminished long-term prognoses. For the most severe PVT cases, a comprehensive approach is critical to further improve outcomes.

In Brief

This is one of the largest studies of adult, primary isolated liver transplantation complicated with portal vein thrombosis. If physiological portal inflow is not reestablished in patients with portal vein thrombosis, they have significantly greater risk of complications due to residual portal hypertension, and thus suffer diminished long-term prognoses.

Author Information

*Miami Transplant Institute, University of Miami and Jackson Memorial Hospital, Miami, FL

DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL

Department of Pathology, University of Miami Leonard M. Miller School of Medicine Miami, FL

§Transplant Center, Carolinas Medical Center, Charlotte, NC

Transplant Center, Cleveland Clinic Florida, Weston, FL.

Reprints: Andreas G. Tzakis, MD, PhD, Transplant Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331. E-mail: tzakisa@ccf.org.

Disclosure: There is no funding to declare. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.