Current management of portal vein thrombosis in liver transplantation. (October 2020)

• Record Type: Journal Article
• Authors: Bhangui, Prashant; Fernandes, Eduardo S.M.; Di Benedetto, Fabrizio; Joo, Dong-Jin; Nadalin, Silvio
• Is Part Of: International journal of surgery. Volume 82(2020)Supplement
• Page Start: 122
• Page End: 127
• Publication Date: 2020-10
• Subjects: Portal vein thrombosis -- PVT grade -- Physiological reconstruction -- Intraoperative management -- Outcomes; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2020.04.068
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Nontumoral portal vein thrombosis (PVT) is present at liver transplantation (LT) in 5–26% of cirrhotic patients, and is known to affect post LT outcomes. Up to 31% of patients who are found to have PVT at the time of LT, would have had PVT at the time of initial listing, but others develop PVT during the waiting period. Adequate screening and treatment of the PVT on the waiting list for LT is thus essential so that a portoportal anastomoses can be performed at the time of LT. Early PVT (Yerdel Grade I/II) can be usually managed by thrombectomy, whereas Grade III PVT may require a jump graft from the superior mesenteric vein to the graft PV. Complete portomesenteric thrombosis is a huge challenge, and sometimes a cause for denying a LT in these patients, with multivisceral transplant being the only alternative. The presence of spontaneous, or previously surgically created portosytemic shunts like the leinorenal shunt, may serve as a good inflow option (renoportal anastomosis) in these patients to establish a physiological reconstruction. Although challenging, good outcomes are possible in patients with complex PVT if the appropriate surgical technique is chosen to ensure portal inflow and resolution of PHT post LT. Highlights: Intra operative management on non tumoral portal vein thrombosis (PVT) is a major challenge for liver transplant surgeons. Cirrhotic patients on the waiting list for liver transplant (LT) should be adequately screened and medical treatment instituted, if indicated. Complex PVT (Yerdel Grade IV, and Jamieson/Charco Grade III/IV) may contraindicate LT in some instances. Physiological inflow into the graft is key to ensure good outcomes post LT in patients with PVT.