title: Liver transplantation in the presence of old portal vein thrombosis.
abstract: BACKGROUND
  Portal vein thrombosis (PVT) has been mentioned as a potential obstacle to liver transplantation (LTx).
  
  
  OBJECTIVE
  To review the impact of PVT on orthotopic liver transplant (OLT) outcome.
  
  
  METHODS
  Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 (7.9%) cases had old PVT with recanalization. Data were retrospectively collected regarding the demographics, indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2-2.5.
  
  
  RESULTS
  The causes of end-stage liver disease were hepatitis B in 11, cryptogenic cirrhosis in 11, primary sclerosing cholangitis in 5 and other causes in 8 recipients. Extension of thrombosis was through confluence of superior mesenteric and splenic vein in 32 and to superior mesenteric vein in 3 patients. The mean±SD operation time was 7.2±1.5 hrs. The mean±SD transfusion requirement was 5.4±2.8 units of packed cells. The mean±SD duration of hospital stay in these patients was 17.7±10.9 days. Eight patients died; 1 developed early in-hospital PVT, 1 had hepatic vein thrombosis, and 1 died of in-hospital ischemic cerebrovascular accident, despite a full anticoagulant therapy. The mean±SD follow-up period for those 28 patients discharged from hospital was 16.6±7.9 months; none of them developed relapse of PVT. The overall mortality and morbidity was 28% and 32%, respectively. There was no relapse of PVT in the other patients.
  
  
  CONCLUSIONS
  The presence of PVT at the time of OLT is not a contraindication for the operation but those with PVT have a more difficult surgery, develop more postoperative complications, and experience a higher in-hospital mortality.
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: F
authors.initials: F
authors.lastname: Kakaei
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Nikeghbalian
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: H
authors.initials: H
authors.lastname: Salahi
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Bahador
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: K
authors.initials: K
authors.lastname: Kazemi
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Dehghani
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Shamsaeefar
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: B
authors.initials: B
authors.lastname: Sanei
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Ghaffaripour
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: E
authors.initials: E
authors.lastname: Rajaei
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Gholami
authors.affiliation: Organ Transplant Research Center, Nemazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: S A
authors.initials: SA
authors.lastname: Malek-Hosseini
keywords: Iran; Portal vein thrombosis; liver transplantationl