title: When and why portal vein thrombosis matters in liver transplantation: a critical audit of 174 cases.
abstract: OBJECTIVE
  To identify complications associated with different techniques utilized to treat portal vein thrombosis (PVT) during primary liver transplantation and their impact on survival.
  
  
  BACKGROUND
  PVT remains an intricate problem in liver transplantation, and the long-term outcomes of patients with PVT who undergo transplantation are not well defined.
  
  
  METHODS
  We performed a retrospective cohort analysis of all consecutive adult patients who underwent primary isolated liver transplantation from 1998 to 2009 (median follow-up period, 89 months). The outcomes of patients with PVT were compared with those without PVT.
  
  
  RESULTS
  Among 1379 recipients, 174 (12.6%) had PVT at the time of transplantation [83 (48%) complete and 91 (52%) partial]. Among PVT patients with reestablished physiological portal inflow (PVT: physiological group; n = 149), 123 underwent thrombectomies, 16 received interpositional vein grafts, and 10 received mesoportal jump grafts. In 25 patients, physiological portomesenteric venous circulation was not reconstituted (PVT: nonphysiological group; 18 underwent cavoportal hemitranspositions, 6 renoportal anastomoses, and 1 arterialization). The PVT: nonphysiological group suffered a significantly increased incidence of rethrombosis of the portomesenteric veins and gastrointestinal bleeding, with a marginal 10-year overall survival rate of 42% (no PVT, 61%; P = 0.002 and PVT: physiological, 55%; P = 0.043). The PVT: physiological and no PVT groups exhibited comparable survival rates (P = 0.13). No significant differences in survival were observed between complete and partial PVT as long as physiological portal flow was reestablished.
  
  
  CONCLUSIONS
  The subset of PVT patients requiring nonphysiological portal vein reconstruction was associated with higher complication rates and suffered diminished long-term prognoses. For the most severe PVT cases, a comprehensive approach is critical to further improve outcomes.
authors.affiliation: *Miami Transplant Institute, University of Miami and Jackson Memorial Hospital, Miami, FL †DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL ‡Department of Pathology, University of Miami Leonard M. Miller School of Medicine Miami, FL §Transplant Center, Carolinas Medical Center, Charlotte, NC ¶Transplant Center, Cleveland Clinic Florida, Weston, FL.
authors.forename: Taizo
authors.initials: T
authors.lastname: Hibi
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: Akin
authors.initials: A
authors.lastname: Tekin
authors.forename: Ji
authors.initials: J
authors.lastname: Fan
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy; D016896:Treatment Outcome; D058017:Vascular Grafting; D020246:Venous Thrombosis / Q000150:complications / Q000401:mortality / Q000601:surgery*