Liver transplantation in a patient with complete portal vein thrombosis, is there a surgical way out? A case report.
BACKGROUND
Due to the complexity of the surgical procedure portal vein thrombosis (PVT) has long been considered an absolute contraindication to liver transplantation (LT). The presence of a large splenorenal shunt (SRS) could make portal anastomosis a valid option.


METHODS
We report the case of a 37-year-old female patient with Grade III PVT and a large SRS, who underwent orthotopic LT. Liver was implanted using a 1992-Belghiti piggyback technique and portal anastomosis was performed using the large spleno-renal shunt. We observed good graft reperfusion and postoperative Doppler ultrasound showed normal portal vein flow. She was discharged on postoperative day 7, with an excellent graft function. At six months follow-up, patient is alive with normal hepatic vascularization.


CONCLUSIONS
Due to paucity of reports, there is currently no consensus on the indication to LT and/or surgical technique. In the present case, once the transplant benefit was evaluated, the Grade III PVT was not considered a contraindication to LT.


CONCLUSIONS
The presence of a Grade III PVT associated with a large SRS should not be considered a contraindication for LT, and the use of the shunt vein should be considered a feasible option to perform portal anastomosis.
Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Viale Oxford n.81, 00133, Rome, Italy.
Tommaso Maria
TM
Manzia
Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Viale Oxford n.81, 00133, Rome, Italy.
Laura
L
Fazzolari
Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Viale Oxford n.81, 00133, Rome, Italy.
Matteo
M
Manuelli
Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Viale Oxford n.81, 00133, Rome, Italy.
Marco
M
Pellicciaro
Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Viale Oxford n.81, 00133, Rome, Italy.
Leonardo
L
Baiocchi
Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Viale Oxford n.81, 00133, Rome, Italy.
Giuseppe
G
Tisone
CT, computed tomography scan; Case report; ICU, Intensive Care Unit; LRV, left renal vein; LT, liver transplantation; Liver transplantation; PVT, portal vein thrombosis; Portal vein thrombosis; SRS, spleno-renal shunt; Spleno-renal shunt