Eversion thrombectomy for portal vein thrombosis during liver transplantation

Area of Science:

• Hepatology
• Vascular Surgery
• Transplantation Medicine

Background:

• Portal vein thrombosis (PVT) is traditionally considered a contraindication for orthotopic liver transplantation (OLT).
• Emerging evidence suggests that OLT may be feasible and successful in select patients with PVT.
• Understanding the incidence, management, and outcomes of PVT in OLT is crucial for patient selection and surgical planning.

Purpose of the Study:

• To investigate the incidence of PVT in patients undergoing primary OLT.
• To analyze the management strategies and outcomes of PVT during OLT, including thrombectomy.
• To evaluate the impact of PVT on patient survival after OLT.

Main Methods:

• Retrospective analysis of 468 OLT cases performed between October 1990 and August 2000.
• Identification of 38 patients (8.1%) with pre-existing PVT.
• Review of preoperative diagnosis, thrombus extension, intraoperative management (thrombectomy and anastomosis), and postoperative outcomes, including rethrombosis and survival rates.

Main Results:

• Preoperative diagnosis of PVT was achieved in only 44.7% of cases, highlighting diagnostic challenges.
• Portal flow was successfully restored in all patients via thrombectomy and end-to-end portal anastomosis.
• One-year actuarial survival rate was 83.7% for patients with PVT, not significantly different from the 86.7% survival in patients without PVT.

Conclusions:

• PVT is often partial and difficult to diagnose preoperatively.
• Surgical thrombectomy is an effective management strategy for PVT during OLT, except in cases of complete splanchnic vein thrombosis.
• PVT, when managed with thrombectomy, does not adversely affect 1-year survival after OLT.