title: Multivisceral transplantation for diffuse portomesenteric thrombosis.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of multivisceral transplantation (MVT) in the setting of diffuse thrombosis of the portomesenteric venous system.
  
  
  BACKGROUND
  Liver transplantation (LT) in the face of cirrhosis and diffuse portomesenteric thrombosis (PMT) is controversial and contraindicated in many transplant centers. LT using alternative techniques such as portocaval hemitransposition fails to eliminate complications of portal hypertension. MVT replaces the liver and the thrombosed portomesenteric system.
  
  
  METHODS
  A database of intestinal transplant patients was maintained with prospective analysis of outcomes. The diagnosis of diffuse PMT was established with dual-phase abdominal computed tomography or magnetic resonance imaging with venous reconstruction.
  
  
  RESULTS
  Twenty-five patients with grade IV PMT received 25 MVT. Eleven patients underwent simultaneous cadaveric kidney transplantation. Biopsy-proven acute cellular rejection was noted in 5 recipients, which was treated successfully. With a median follow-up of 2.8 years, patient and graft survival were 80%, 72%, and 72% at 1, 3, and 5 years, respectively. To date, all survivors have good graft function without any signs of residual/recurrent features of portal hypertension.
  
  
  CONCLUSIONS
  MVT can be considered as an option for the treatment of patients with diffuse PMT. MVT is the only procedure that completely reverses portal hypertension and addresses the primary disease while achieving superior survival results in comparison to the alternative options.
authors.affiliation: Department of Surgery, Division of Transplantation, Indiana University School of Medicine, Indianapolis, IN 46202, USA. rvianna@iupui.edu
authors.forename: Rodrigo M
authors.initials: RM
authors.lastname: Vianna
authors.forename: Richard S
authors.initials: RS
authors.lastname: Mangus
authors.forename: Chandrashekhar
authors.initials: C
authors.lastname: Kubal
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.forename: Thiago
authors.initials: T
authors.lastname: Beduschi
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008642:Mesenteric Veins; D008875:Middle Aged; D016377:Organ Transplantation; D011169:Portal Vein; D012189:Retrospective Studies; D017131:Thrombectomy; D013927:Thrombosis / Q000601:surgery*; D014781:Viscera / Q000637:transplantation*