An early single-center experience of portal vein thrombosis in living donor liver transplantation: Clinical feature, management and outcome

Division of Hepatobiliary and Transplantation Surgery, Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.
Journal of the Korean Surgical Society 07/2011; 81(1):35-42. DOI: 10.4174/jkss.2011.81.1.35
Source: PubMed


Portal vein thrombosis (PVT) has been considered a relative contraindication for living donor liver transplantation (LDLT). However, it is no longer a contraindication of LDLT due to improvement in surgical techniques and approaches to PVT. The aim of this study was to assess the impact of PVT on outcomes in LDLT patients.
We retrospectively analyzed the data from 97 adult patients undergoing LDLT in our center from July 2008 to June 2010. Intraoperative findings and preoperative imaging results were reviewed for PVT grading (Yerdel grading). We analyzed the technical aspects and comparisons of risk factors, perioperative variables, and survivals between patients with and without PVT based on the grades.
In the 97 LDLT patients, 18 patients were confirmed to have PVT (18.5%) including grade I cases (n = 8), grade II (n = 7), and grade III (n = 3). Prior treatment of portal hypertension was found to be an independent risk factor for PVT (P = 0.001). The comparisons between PVT and no PVT groups showed no significant difference in intraoperative and postoperative variables except for postoperative bleeding (P = 0.036). The short-term portal vein patency, in-hospital mortality and survival rates were not significantly different between the PVT and control groups.
The outcomes are similar to non-PVT group in terms of in-hospital mortality, survival rates, and postoperative complications. Therefore, our study suggests that PVT cannot be considered to be a contraindication for LDLT and LDLT could be undertaken without increased morbidity and mortality in patients with PVT, in spite of operative complexity.

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    • "Even though liver transplantation became the standard treatment for ESLD and early-stage HCC and the number of liver transplant programs is rapidly increasing all over the world, there are a limited number of recent publications about outcomes from new liver transplant programs [9,10,11]. "
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    ABSTRACT: Purpose To evaluate patient triage pattern and outcomes according to types of liver transplantation as part of a new liver transplant program developed in an East Asian country with a limited number of deceased donors. Methods Medical records of initial 50 liver transplantations were reviewed retrospectively. Results Twenty-nine patients underwent deceased donor liver transplantation (DDLT) and 21 patients underwent living donor liver transplantation (LDLT). Mean model for end-stage liver disease scores of recipients of DDLT and LDLT were 24.9 ± 11.6 and 13.1 ± 5.4, respectively (P < 0.0001). Twenty-eight patients had HCCs and 17 of them (60.7%) underwent LDLT, which was 80.9% of LDLTs. There were 2 cases of perioperative mortality; each was from DDLT and LDLT, respectively. Median follow-up was 18 months. Overall patient and graft survival rates at 6 months, 1 and 2 years were 95.7%, 93.4%, and 89.8%, respectively. There was no significant difference in survival between DDLT and LDLT. Overall recurrence-free survival rates of hepatocellular carcinoma (HCC) patients at 6 month, 1, and 2 years were 96.3%, 96.3%, and 90.3%, respectively. There was no significant difference in recurrence-free survival between DDLT and LDLT. Conclusion As a new liver transplant program with limited resource and waiting list, patients with critical condition could undergo DDLT whereas relatively stable patients with HCCs were mostly directed to LDLT. We recommend a balanced approach between DDLT and LDLT for initiating liver transplant programs.
    Annals of Surgical Treatment and Research 07/2014; 87(1):22-7. DOI:10.4174/astr.2014.87.1.22
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    ABSTRACT: Diffuse porto-mesenteric thrombosis is considered to be a contraindication to living donor liver transplantation (LDLT) by numerous transplant centers. We report a successful case of LDLT with cavo-portal hemitransposition (CPHT) in a 36 year old male who presented with diffuse porto-mesenteric thrombosis and de-compensated end stage liver disease. Intraoperatively, the splenic artery was ligated to ameliorate portal hypertension and hypersplenism, and a LDLT with a right lobe graft was performed. In the presence of the porto-systemic collaterals, an end-to-end CPHT was fashioned, instead of a renoportal anastomosis, to provide portal inflow to the allograft. The graft to recipient body weight ratio was 1.06. The cold and warm ischaemia times were 119 and 64 minutes, respectively. Intraoperative Doppler ultrasonography of the allograft demonstrated good portal and arterial inflows with a normal venous outflow. Post-operatively, the patient had transient renal dysfunction that recovered gradually over a period of 19 days. He also had one episode of hematemesis due to persistent portal hypertension and required blood and platelet transfusions for pancytopenia due to hypersplenism. At follow-up after 26 months post-transplant, he is alive and well, his liver and renal functions tests are normal and CT angiography and Doppler ultrasonography showed a patent cavo-portal anastomosis with good flow. We have demonstrated that LDLT with CPHT can be performed safely in selected patients with diffuse port-mesenteric thrombosis. Key words: Portal vein thrombosis, Liver transplantation, Cavoportal hemitransposition, Portal hypertension
    Liver Transplantation 01/2015; 21(1):135-139. DOI:10.1002/lt.24008 · 4.24 Impact Factor
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    ABSTRACT: Background Improved outcomes have been shown in liver transplantation (LT) with portal vein thrombosis (PVT). However, PVT is still discovered incidentally during surgery despite careful pre-operative imaging. Data is limited comparing the outcomes of incidental PVT with PVT diagnosed via pre-operative imaging prior to LT. This study aims to compare the overall outcomes of patients with PVT.MethodologyFrom 2008 to 2012, 369 patients had LT and 58 patients with PVT were identified. They were divided into those with non-PVT, n=311 (Group 0), pre-operative identified PVT, n=28 (Group 1) and incidental PVT, n=30 (Group 2). The demographics, characteristics, pre-operative assessment and post-operative outcomes were compared. Survival analysis was also performed.ResultsBaseline characteristics and pre-operative evaluation of all 3 groups were comparable (p>0.05) except for MELD score, tumour status, platelet levels and serum bilirubin. A multivariate analysis only showed a high serum bilirubin levels to be a predictor of PVT (p=0.004, OR = 3.395, 95% CI - 1.467-7.861). Post-operative outcomes were also comparable (p>0.05). Group 1 had more patients with Yerdel 3 or 4 compared to Group 2 with more extensive surgical intervention required (p=0.021). Survival analysis in all 3 groups was comparable with 5-year survival rate of 87.4%, 84.6%, and 91.8% in Group 0, 1 and 2 respectively (p=0.657).Conclusion Recipients with PVT undergoing LT can have similar outcome as the non-PVT even if PVT were discovered incidentally. Discovery of incidental PVT only requires thrombectomy with no substantial change of treatment strategy where outcome is not adversely affected, as most are of lower Yerdel grade. Pre-operative imaging is useful to identify those with higher Yerdel grade to allow planning of surgical strategy during transplantation. This article is protected by copyright. All rights reserved.
    Liver Transplantation 04/2015; 21(7). DOI:10.1002/lt.24149 · 4.24 Impact Factor