title: Caval inflow to the graft for liver transplantation in patients with diffuse portal vein thrombosis: a 12-year experience.
abstract: OBJECTIVE
  To analyze the short- and long-term results of cavoportal anastomosis (CPA) and renoportal anastomosis (RPA) in 20 consecutive liver transplantation (LT) candidates with diffuse portal vein thrombosis (PVT).
  
  
  BACKGROUND
  Caval inflow to the graft (CIG) by CPA or RPA has been the most commonly used salvage technique to overcome the absolute contraindication for LT in case of diffuse PVT.
  
  
  METHODS
  From 1996 to 2009, 3 patients (15%) underwent CPA and 17 patients (85%) had an RPA during LT. In addition to routine follow-up, patients were specifically evaluated for signs of portal hypertension (PHT) and for patency of the anastomoses. The follow-up ranged from 3 months to 12 years (median of 4.5 years).
  
  
  RESULTS
  : Caval inflow to the graft was feasible in all attempted cases. In the short term (<6 months), 35% of patients had residual PHT-related complications (massive ascites and variceal bleeding). These resolved spontaneously or with endoscopic management. Three deaths occurred; none was related to PHT or shunt thrombosis. In the long term (>6 months), 1 death occurred because of recurrent variceal bleeding after RPA thrombosis. At last follow-up, all living patients [n = 13 (65%)] had normal liver function, no signs of PHT and patent anastomoses. There were no retransplantations. Graft and patient survival at 1, 3, and 5 years were 83%, 75%, and 60%, respectively.
  
  
  CONCLUSIONS
  Caval inflow to the graft is an efficacious salvage technique with satisfactory long-term results, considering the spontaneous outcome in patients denied LT because of diffuse PVT. Adequate preoperative management of PHT and its associated complications is vital in obtaining good results. In the long term, residual PHT resolves and the liver function returns to normal.
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif Cedex, France.
authors.forename: Prashant
authors.initials: P
authors.lastname: Bhangui
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.forename: Paola
authors.initials: P
authors.lastname: Andreani
authors.forename: Mylene
authors.initials: M
authors.lastname: Sebbagh
authors.forename: Emir
authors.initials: E
authors.lastname: Hoti
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichai
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Rene
authors.initials: R
authors.lastname: Adam
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D012082:Renal Veins / Q000601:surgery; D016879:Salvage Therapy; D017131:Thrombectomy; D020246:Venous Thrombosis / Q000601:surgery*