Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation.
OBJECTIVE
To determine the efficacy of portal thrombendvenectomy in cases of portal vein thrombosis at the time of orthotopic liver transplantation.


BACKGROUND
Portal vein thrombosis (PVT) has been reported to have an incidence of 2% to 39% in end-stage liver disease. Multiple techniques have been suggested to treat this finding. Several reports have suggested suboptimal results after liver transplantation in recipients with PVT.


METHODS
The authors prospectively collected data on 1,546 patients who underwent an initial orthotopic liver transplant at the authors' institution between December 1984 and October 1999. There were 820 male patients and 726 female patients. All recipients received either cyclosporine or tacrolimus immunosuppression. Intraoperative flows of the portal vein and hepatic artery were routinely measured. Duplex sonography was routinely performed on the first postoperative day and routinely 1, 2, 5, and 10 years after transplantation. Eighty-five patients underwent thrombendvenectomy for organized thrombus partially or completely occluding the portal vein. Postoperative treatment included low-molecular-weight dextran for 48 hours and daily aspirin for 3 months. There were 53 male patients and 32 female patients. The PVT group was compared with a control group consisting of transplant recipients without PVT.


RESULTS
When compared with the control group, PVT patients were older at the time of transplantation and had a higher incidence of liver disease secondary to cryptogenic cirrhosis and Laennec's cirrhosis. There were no significant differences among both groups for 1-, 3-, and 6-year patient and graft survival rates.


CONCLUSIONS
Thrombendvenectomy provides a rapid resolution of an otherwise complex problem. It is the authors' procedure of choice in cases of organized PVT at the time of transplantation. Operative time and length of stay in the intensive care unit are not prolonged, and patient and graft survival rates are not compromised.
Molmenti
Ernesto P
EP
Baylor University Medical Center, Dallas, Texas 75246, USA.
Roodhouse
Thomas W
TW
Molmenti
Hebe
H
Jaiswal
Kshama
K
Jung
Ghap
G
Marubashi
Shigeru
S
Sanchez
Edmund Q
EQ
Gogel
Brian
B
Levy
Marlon F
MF
Goldstein
Robert M
RM
Fasola
Carlos G
CG
Elliott
Eric E
EE
Bursac
Nevenka
N
Mulligan
David
D
Gonwa
Thomas A
TA
Klintmalm
Goran B
GB
D000075202:Contraindications; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011446:Prospective Studies; D017131:Thrombectomy; D013927:Thrombosis / Q000601:surgery*