title: Single center experience of 39 patients with preoperative portal vein thrombosis among 404 adult living donor liver transplantations.
abstract: Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) involves technical difficulty. The aim of this research was to analyze their preoperative diagnosis of PVT, operative procedures, and postoperative courses of patients with preoperative PVT. Thirty-nine patients of 404 adult patients (9.7%) undergoing LDLT in our hospital from 1996 June to 2004 December had PVT at their transplantation. Twenty-nine patients had intractable ascites, 21 had gastrointestinal bleeding, and 18 had encephalopathy. The thrombus was located in the portal trunk in 23, in the portal trunk and superior mesenteric vein (SMV) in 7, and developed into the SMV and the splenic vein in 8. The occlusive grade was partial in 29, and complete in 10 patients. The thrombus was removed by a simple technique, and eversion and/or incision technique, or total removal of the portal vein (PV). The PV was reconstructed with the thrombectomized native PV, with an interposed vein graft, or porto-caval hemitransposition. Advanced PVT had a significant impact on blood loss and hospital mortality. Three out of 10 patients with residual PVT required radiological and/or surgical intervention after transplantation. In conclusion, thorough planning is essential for a successful LDLT outcome for patients with preexisting PVT.
authors.affiliation: Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan. egawa@kuhp.kyoto-u.ac.jp
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Oike
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Kozaki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Taira
authors.forename: Takashi
authors.initials: T
authors.lastname: Ito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000379:methods*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery