Salvage procedure for unexpected portal vein thrombosis in living donor liver transplantation.
Portal vein thrombosis (PVT) is considered a relative contraindication to living donor liver transplantation (LDLTx) due to technical difficulty and ethical considerations. So far, there have been a few reported cases of LDLTx with PVT, most of which were treated by thrombectomy with or without a venous conduit. We report a case of LDLTx in an unexpected recipient with grade 4 diffuse PVT, which was successfully managed using a variceal left gastric vein and a deceased donor iliac vein conduit to create a "de novo portal vein" for splanchnic inflow to the right lobe. The patient experienced an uneventful postoperative course with normal blood flow in the de novo portal vein at 1-year follow up. This report demonstrated that a variceal collateral vein can be used as appropriate alternative inflow for the right lobe in LDLTx cases in which an unexpected PVT is encountered.
Maluf
D
D
Division of Transplantation Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia 23298-0248, USA.
Shim
I
I
Posner
M
M
Cotterell
A H
AH
Fisher
R A
RA
D006801:Humans; D007084:Iliac Vein / Q000601:surgery; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011169:Portal Vein / Q000601:surgery*; D016879:Salvage Therapy; D013270:Stomach / Q000294:innervation; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D016896:Treatment Outcome