Ten-year experience in porto-caval hemitransposition for liver transplantation in the presence of portal vein thrombosis.
Porto-caval hemitransposition (PCH) in liver transplantation allows revascularization of the liver when the porto-mesenteric axis is thrombosed. We, here, review our experience over an 11-year period. A total of 23 patients underwent liver transplantation using PCH. Immunosuppression was based on tacrolimus, with sirolimus used in case of renal insufficiency. Most common diagnoses were hepatitis C, Laennec's, Budd-Chiari and cryptogenic cirrhosis. Six patients needed splenectomy prior to transplant, 5 during transplant, 1 post-transplant, 11 had no splenectomy. Overall survival was 60% at 1 year and 38% at 3 years, with 10 of 23 patients currently alive and the longest survivor at 9.3 years. Most common cause of death was sepsis/multisystem organ failure, followed by pulmonary embolism. A total of 7/23 patients experienced post-operative gastrointestinal bleeding episodes, 6/23 patients developed thrombosis of the vena cava (median 162 days post-op). Post-operative ascites was noted in almost all patients. Renal dysfunction was commonly seen even after the first month post-transplant. PCH offers a feasible option for liver transplantation in those patients with complex thrombosis of the mesenteric and portal circulation.
Selvaggi
G
G
Division of Liver and GI Transplantation, University of Miami Miller School of Medicine, Miami, Florida, USA. gselvaggi@med.miami.edu
Weppler
D
D
Nishida
S
S
Moon
J
J
Levi
D
D
Kato
T
T
Tzakis
A G
AG
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D006502:Budd-Chiari Syndrome / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007668:Kidney / Q000502:physiology; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011169:Portal Vein / Q000601:surgery*; D015996:Survival Rate; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin