Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality.
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.
Lladó
Laura
L
Department of Surgery, Liver Transplant Unit, H.U. Bellvitge, University of Barcelona, Barcelona, Spain. 31513llg@comb.es
Fabregat
Juan
J
Castellote
José
J
Ramos
Emilio
E
Torras
Jaume
J
Jorba
Rosa
R
Garcia-Borobia
Francisco
F
Busquets
Juli
J
Figueras
Juan
J
Rafecas
Antoni
A
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*