Portal Vein Thrombosis, Management and Approaches in Liver Transplantation: A Narrative Review

This review delves into the complexities of managing portal vein thrombosis (PVT) in the context of liver transplantation (LT). PVT, which is a common finding in cirrhotic livers, can significantly jeopardize LT outcomes. Here, we explore the incidence, underlying mechanisms, and comprehensive management strategies for PVT throughout the pre-, intra-, and postoperative phases of LT in cirrhotic patients. Before transplantation, key interventions include anticoagulation therapies, transjugular intrahepatic portosystemic shunts (TIPS), and various endovascular techniques aimed at recanalizing the portal vein. During LT, surgical approaches range from straightforward eversion thrombectomy to more intricate procedures, such as jump grafts from the superior mesenteric vein (SMV), renoportal anastomosis (RPA), and portocaval hemitransposition, tailored to the extent of the thrombosis. In cases of extensive PVT, multivisceral transplantation (MVT) emerges as a viable option. Post-transplant management centers on thromboprophylaxis and anticoagulation, balancing the prevention of thrombotic events with the risk of bleeding complications. This review underscores the critical importance of early identification and proactive management of PVT to enhance outcomes for LT candidates.