title: Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality.
abstract: BACKGROUND
  Splanchnic thrombosis is a surgical challenge in liver transplantation (LT). The aim of this study was to analyze our experience in the management of portal vein thrombosis, and its influence on evolution.
  
  
  OBJECTIVE
  The aim of this study was to analyze our experience in the management of portal vein thrombosis, and its influence on evolution.
  
  
  METHODS
  Between 1999 and 2004, 366 liver transplants were performed in 335 patients. Forty-two patients [12.5%: portal vein thrombosis (PVT) group] had portal thrombosis at the time of LT. We analyzed the technical aspects and compared their evolution with a group of patients without portal thrombosis (n = 293; no-PVT group). Retransplantations were excluded.
  
  
  RESULTS
  Of the 42 patients with thrombosis, 18 had partial thrombosis and 16 complete thrombosis [six included the proximal superior mesenteric vein (SMV) and in two the whole splanchnic system]. In 12 cases, usual T-T anastomosis was performed and in 16 cases a thrombectomy was carried out; there were five cases of anastomosis at confluence of the SMV, five cases of anastomosis to a collateral vein, three cases of venous graft, and one case of cavoportal hemitransposition. The operative time was higher in PVT group (417 +/- 103 min vs. 363 +/- 83; p = 0.0005), as RBC transfusion (2.4 +/- 3.1 vs. 1.9 +/- 2.3; p = 0.04), and hospital stay (20.9 +/- 14.9 d vs. 15.1 +/- 10.6; p = 0.002). However, there were no differences in hospital mortality (4% vs. 7.8%; p = 0.98), primary dysfunction (4.8% vs. 7.8%; p = 0.44), or three-yr-actuarial survival (75% vs. 77%; p = 0.95). The incidence of post-transplant thrombosis was higher in the PVT group (15% vs. 2.4%; p = 0.0005).
  
  
  CONCLUSIONS
  Portal thrombosis is associated with greater operative complexity and rethrombosis, but has no influence on overall morbidity and mortality.
authors.affiliation: Department of Surgery, Liver Transplant Unit, H.U. Bellvitge, University of Barcelona, Barcelona, Spain. 31513llg@comb.es
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó
authors.forename: Juan
authors.initials: J
authors.lastname: Fabregat
authors.forename: José
authors.initials: J
authors.lastname: Castellote
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramos
authors.forename: Jaume
authors.initials: J
authors.lastname: Torras
authors.forename: Rosa
authors.initials: R
authors.lastname: Jorba
authors.forename: Francisco
authors.initials: F
authors.lastname: Garcia-Borobia
authors.forename: Juli
authors.initials: J
authors.lastname: Busquets
authors.forename: Juan
authors.initials: J
authors.lastname: Figueras
authors.forename: Antoni
authors.initials: A
authors.lastname: Rafecas
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011169:Portal Vein; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D017131:Thrombectomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014656:Vascular Surgical Procedures / Q000379:methods*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*