Surgical complications following liver transplantation in patients with portal vein thrombosis--a single-center perspective.
BACKGROUND
Portal vein thrombosis (PVT) was once considered a contraindication for liver transplantation (LTx) because of technical difficulties. Though no longer a contraindication, it remains a risk factor.


OBJECTIVE
A study of surgical complications following LTx in patients with and without PVT.


METHODS
A retrospective review of 1,171 consecutive patients who underwent LTx between June 1995 and June 2007 was performed, and 78 recipients with PVT (study group) were compared with a stratified random sample of 78 contemporous recipients without PVT (control group) for postoperative complications. Both groups were comparable with respect to age, sex, race, and other confounding variables.


RESULTS
The rate of primary nonfunction (PNF) in the study and control groups was 9.0% and 1.3%, (p = 0.063), while that of retransplantation was 17.9% and 7.7% (p = 0.055), respectively. The mean donor risk index (DRI) among the patients with and without PNF in the study group was 2.58 +/- 0.44 and 2.08 +/- 0.42, respectively (p = 0.014). A significantly higher number of packed red blood cells and fresh frozen plasma transfusions were observed in study group compared to controls (p = 0.012, 0.007, respectively).


CONCLUSIONS
A higher rate of PNF was related to the complexity of the surgical procedure and the use of donor livers with a high DRI. Higher rates of PNF eventually led to a higher rate of retransplant. A strategy of offering donor livers with a low DRI might be helpful in decreasing the rate of PNF. Further, a PV interposition graft in difficult cases instead of thrombectomy could lead to a lower rethrombosis rate.
Sharma
Rajeev
R
Division of Solid Organ Transplantation, Department of Surgery, University of Rochester Medical Center, Box SURG, Rochester, NY 14620, USA. drsharma.r@gmail.com
Kashyap
Randeep
R
Jain
Ashok
A
Safadjou
Saman
S
Graham
Maureen
M
Dwivedi
Alok Kumar
AK
Orloff
Mark
M
D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008102:Liver Circulation / Q000502:physiology; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D010690:Phlebography / Q000379:methods; D011169:Portal Vein; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011336:Probability; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D017131:Thrombectomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*