Resolution of preoperative portal vein thrombosis after administration of antithrombin III in living donor liver transplantation: case report.
A 59-year-old man with hepatitis C virus-associated liver cirrhosis was transferred to our hospital to undergo living donor liver transplantation. Coagulation was impaired (prothrombin time [International Normalized Ratio], 3.27), and antithrombin III (AT-III) activity was 23% (normal, 87%-115%). Contrast-enhanced computed tomography scans revealed portal vein thrombosis (PVT) from the junction between the splenic and superior mesenteric vein to the porta hepatica; the portal vein was completely obstructed (PVT). To prevent further development of PVT, 1500 U of AT-III was administered for 3 days, elevating the AT-III activity to 50%. A contrast-enhanced computed tomography scan obtained 9 days after AT-III administration showed resolution of PVT. Living donor liver transplantation was safely performed without portal vein grafting. Thus, a low AT-III concentration may have an important role in the pathogenesis of PVT in patients with cirrhosis.
Imai
H
H
Department of Hepatobiliary Pancreas and Transplant Surgery, Kyoto University, Kyoto, Japan.
Egawa
H
H
Kajiwara
M
M
Nakajima
A
A
Ogura
Y
Y
Hatano
E
E
Ueda
M
M
Kawaguchi
Y
Y
Kaido
T
T
Takada
Y
Y
Uemoto
S
S
D000990:Antithrombin III / Q000627:therapeutic use*; D001663:Bilirubin / Q000097:blood; D006501:Hepatic Encephalopathy / Q000601:surgery*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D012771:Shock, Hemorrhagic / Q000150:complications; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*
D000990:Antithrombin III; D001663:Bilirubin