title: Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation.
abstract: 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.
authors.affiliation: Baylor University Medical Center, Dallas, Texas 75246, USA.
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Roodhouse
authors.forename: Hebe
authors.initials: H
authors.lastname: Molmenti
authors.forename: Kshama
authors.initials: K
authors.lastname: Jaiswal
authors.forename: Ghap
authors.initials: G
authors.lastname: Jung
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Edmund Q
authors.initials: EQ
authors.lastname: Sanchez
authors.forename: Brian
authors.initials: B
authors.lastname: Gogel
authors.forename: Marlon F
authors.initials: MF
authors.lastname: Levy
authors.forename: Robert M
authors.initials: RM
authors.lastname: Goldstein
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Fasola
authors.forename: Eric E
authors.initials: EE
authors.lastname: Elliott
authors.forename: Nevenka
authors.initials: N
authors.lastname: Bursac
authors.forename: David
authors.initials: D
authors.lastname: Mulligan
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gonwa
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
mesh_terms: 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*