Liver transplantation in recipients with portal vein thrombosis: experience of a single transplant center.
BACKGROUND
Although portal vein thrombosis (PVT) is no longer considered a contraindication for liver transplantation (OLT), it is still considered a high risk because of the complexity of the surgical procedure. The aim of this study was to evaluate the impact of PVT in the recipient during OLT on intra- and perioperative management and outcome.


METHODS
Between April 1986 and October 2003, 721 primary OLT included 64 patients (8.8%) with PVT. The underlying liver disease was postnecrotic cirrhosis in most cases (n = 37). Intraoperative (length of surgery, packed red blood cells (PRBC) transfusion requirements, ischemia time, complications) and postoperative parameters (ICU stay and hospitalization time, complications, actuarial graft and patient survival at 1 month and 1 and 5 years) were compared with a control group of patients submitted to OLT without PVT (n = 657).


RESULTS
Portal flow was reestablished in 56 patients with thromboendovenectomy, in seven patients with a venous graft from the superior mesenteric vein, and with cavoportal hemitransposition in one case. The average ICU and hospital stay as well as the 1-month and 1- and 5-year patient survivals were not significantly different in the PVT versus the control group. We observed slightly more PRBC transfusions and longer surgery procedures in the PVT group.


CONCLUSIONS
Our experience suggests that thromboendovenectomy is the procedure of choice for PVT. The results are good in terms of survival rates and postoperative complications, although the presence of PVT may lead to more technical problems during surgery.
Bertelli
R
R
University of Bologna, Bologna, Italy.
Nardo
B
B
Montalti
R
R
Beltempo
P
P
Puviani
L
L
Cavallari
A
A
D001803:Blood Transfusion; D006085:Graft Survival; D006801:Humans; D007430:Intraoperative Care; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000473:pathology*; D018616:Ultrasonography, Doppler, Duplex