A selective approach to preexisting portal vein thrombosis in patients undergoing liver transplantation.
Splanchnic venous inflow is considered mandatory to ensure graft survival after liver transplantation. Over a 68-month period, we performed 570 liver transplants in 495 patients. Portal vein thrombosis was present in 16 patients. At transplant, the extent of the occlusion included portal vein alone (n = 4), portal including confluence of the splenic and superior mesenteric veins (n = 8), portal, splenic, and distal superior mesenteric veins (n = 2), and the entire portal vein, splenic vein, and superior mesenteric vein (n = 2). The operative approach included thrombectomy alone (n = 5), anastomosis at the confluence of the splenic and superior mesenteric splenic veins (n = 8), and extra-anatomic venous reconstruction (n = 3). The mean operative blood loss was 22 +/- 22 units, and the mean operative time was 9.7 +/- 4.8 hours. The 1-year actuarial survival rate was 81%, with a mean follow-up of 12.5 months. In summary, with a selective approach and the use of innovative forms of splanchnic venous inflow, portal vein thrombosis is no longer a contraindication to liver transplantation.
Langnas
A N
AN
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Marujo
W C
WC
Stratta
R J
RJ
Wood
R P
RP
Ranjan
D
D
Ozaki
C
C
Shaw
B W
BW
D000206:Actuarial Analysis; D002675:Child, Preschool; D000075202:Contraindications; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology; D008875:Middle Aged; D011169:Portal Vein; D013927:Thrombosis / Q000601:surgery*