title: Cavoportal hemitransposition: a successful way to overcome the problem of total portosplenomesenteric thrombosis in liver transplantation.
abstract: Orthotopic liver transplantation (OLT) may be feasible even in the presence of diffuse portal vein thrombosis (PVT) in the recipient, providing hepatopetal portal flow to the graft can be ensured. Cavoportal hemitransposition was used in selected cases in which no other salvage solutions were technically possible. We report our experience of two patients with diffuse thrombosis of the entire portal system. One patient also had thrombosis of a previous portacaval shunt with a synthetic interposition graft. Portal pedicle dissection and native hepatectomy (with or without vena cava removal) appeared difficult. Bleeding from the exposed area was severe, and in one case, a new laparotomy was necessary to stop the abdominal hemorrhage. The postoperative course was complicated by severe ascites (with fluid infection and surgically drained suprahepatic abscess in one case), renal insufficiency (requiring dialysis in one case), esophagogastric variceal bleeding (needing several sessions of endoscopic treatment), and bronchopneumonic infections (in one case, superinfection with Aspergillus fumigatus despite amphotericin B lipid complex therapy led to the patient's death from multiorgan failure). Our experience was compared with 17 other cases in the literature. Etiologic factors, preoperative diagnostics, surgical problems, and postoperative complications are focused on and discussed. Diffuse PVT no longer appears to be an absolute contraindication to OLT, although cavoportal hemitransposition needs further experience and long-term follow-up.
authors.affiliation: Department of Medical and Surgical Sciences, III Surgical Clinic, Padua University, Padua, Italy. giorgio.gerunda@unipd.it
authors.forename: Giorgio E
authors.initials: GE
authors.lastname: Gerunda
authors.forename: Roberto
authors.initials: R
authors.lastname: Merenda
authors.forename: Daniele
authors.initials: D
authors.lastname: Neri
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.forename: Franco
authors.initials: F
authors.lastname: Barbazza
authors.forename: Michele
authors.initials: M
authors.lastname: Valmasoni
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Fabio
authors.initials: F
authors.lastname: Zangrandi
authors.forename: Antonio
authors.initials: A
authors.lastname: Gangemi
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gagliesi
authors.forename: Alvise Maffei
authors.initials: AM
authors.lastname: Faccioli
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D017809:Fatal Outcome; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000601:surgery*