Eversion thrombectomy for portal vein thrombosis during liver transplantation.
Portal vein thrombosis (PVT) has been seen as an obstacle to orthotopic liver transplantation (OLT), but recent data suggest that favorable results may be achieved in this group of patients. The aim of this study was to analyze the incidence, management, and survival of patients with PVT undergoing primary OLT with thrombectomy. Between October 1990 and August 2000, 468 liver transplantations were performed in our center and portal vein thrombosis was present in 38 patients (8.1%). Preoperative diagnosis, extension, intraoperative management, postoperative recurrence of portal vein thrombosis, and 1-year actuarial survival rates were retrospectively studied. Preoperative diagnosis was made in 17 cases (44.7%). In all patients, portal flow was restored after portal vein thrombectomy, followed by usual end-to-end portal anastomosis. All patients received preventive low-weight heparin from day 2 to hospital discharge, and then aspirin. Rethrombosis was observed in one patient with extended splanchnic thrombus. The 1-year actuarial patient survival rate was 83.7%, and did not significantly differ from the patients without portal vein thrombosis (86.7%). Our results suggest that portal vein thrombosis is often partial and thus difficult to diagnose preoperatively: it can be managed successfully during surgery by thrombectomy, except when there is complete splanchnic veins thrombosis; and it did not affect 1-year survival.
Dumortier
Jérĵme
J
Unité de Transplantation Hépatique, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France.
Czyglik
Olivier
O
Poncet
Gilles
G
Blanchet
Marie-Cécile
MC
Boucaud
Catherine
C
Henry
Luc
L
Boillot
Olivier
O
D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008499:Medical Records; D011169:Portal Vein / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*