Related Experiment Video
Updated: Mar 30, 2026
New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation
Published on: June 27, 2025
Systemic Venous Inflow to the Liver Allograft to Overcome Diffuse Splanchnic Venous Thrombosis
Cristian Lupascu1, Tom Darius2, Pierre Goffette3
1Department of Surgery, University of Medicine and Pharmacy "Gr.T.Popa", University Hospital St. Spiridon, Iasi, Romania ; Starzl Unit of Abdominal Transplantation, Cliniques Universitaires St. Luc, Université Catholique de Louvain (UCL), 1200 Brussels, Belgium.
Insights
Extensive splanchnic venous thrombosis (DSVT) is manageable for liver transplantation (LT). Surgical techniques like cavoportal hemitransposition offer life-saving alternatives, enabling long-term survival in select patients.
Area of Science:
- Hepatology
- Vascular Surgery
- Transplantation Medicine
Background:
- Diffuse splanchnic venous thrombosis (DSVT) was historically considered a contraindication for liver transplantation (LT).
- Managing DSVT presents significant challenges for liver transplant surgeons.
- Alternative surgical strategies are crucial for patients with extensive splanchnic venous thrombosis.
Purpose of the Study:
- To evaluate the feasibility and outcomes of liver transplantation in patients with extensive splanchnic venous thrombosis.
- To assess the efficacy of surgical techniques such as cavoportal hemitransposition and renoportal anastomosis in managing DSVT during LT.
- To determine the long-term survival and complication rates in LT recipients with DSVT.
Main Methods:
- Retrospective analysis of five patients with preoperatively confirmed extensive splanchnic venous thrombosis undergoing liver transplantation.
- Surgical interventions included cavoportal hemitransposition (n=4) and renoportal anastomosis (n=1).
- Median follow-up duration was 58 months (range: 0.5–130 months).
Main Results:
- Three out of five patients achieved excellent long-term survival post-transplantation.
- Two patients with prior radiation-induced peritoneal injury experienced early mortality (18 days and 2 months).
- Two long-term survivors required reintervention for severe gastrointestinal bleeding, highlighting potential complications.
Conclusions:
- Extensive splanchnic venous thrombosis is no longer an absolute contraindication for liver transplantation.
- Cavoportal hemitransposition and renoportal anastomosis are life-saving procedures that ensure adequate allograft portal flow.
- Despite their efficacy, these techniques necessitate careful patient follow-up due to the persistent risk of (segmental) portal hypertension complications.
Abstract:
Diffuse splanchnic venous thrombosis (DSVT), formerly defined as contraindication for liver transplantation (LT), is a serious challenge to the liver transplant surgeon. Portal vein arterialisation, cavoportal hemitransposition and renoportal anastomosis, and finally combined liver and small bowel transplantation are all possible alternatives to deal with this condition. Five patients with preoperatively confirmed extensive splanchnic venous thrombosis were transplanted using cavoportal hemitransposition (4x) and renoportal anastomosis (1x). Median follow-up was 58 months (range: 0,5 to 130 months). Two patients with previous radiation-induced peritoneal injury died, respectively, 18 days and 2 months after transplantation. The three other patients had excellent long-term survival, despite the fact that two of them needed a surgical reintervention for severe gastrointestinal bleeding. Extensive splanchnic venous thrombosis is no longer an absolute contraindication to liver transplantation. Although cavoportal hemitransposition and renoportal anastomosis undoubtedly are life-saving procedures allowing for ensuring adequate allograft portal flow, careful follow-up of these patients remains necessary as both methods are unable to completely eliminate the complications of (segmental) portal hypertension.
