Living Donor Liver Transplantation in Patients With Portal Vein Thrombosis: A Single-Center Experience

Portal vein thrombosis (PVT) is a significant vascular complication in liver transplant candidates, necessitating modifications in surgical techniques and increasing the risk of postoperative complications. This study aimed to evaluate postoperative thrombotic complications, the need for reoperation, survival, and mortality rates after living donor liver transplantation (LDLT) in patients with preoperative PVT.

Forty-nine patients diagnosed with preoperative PVT undergoing LDLT between July 2021 and August 2024 at our center were retrospectively reviewed. Patients were classified according to the Yerdel classification. Surgical techniques, portal vein reconstruction, associated diseases, MELD/PELD scores, postoperative PVT occurrence, the need for reoperation, and survival data were analyzed.

Postoperative PVT developed in 6 patients (12.2%); 3 of these patients (6.1%) required reoperation. Overall, mortality occurred in 13 patients (26.5%); 3 cases were due to non-PVT-related reasons (sepsis following ERCP/PTC or sudden cardiac arrest). The PVT-related mortality rate was 20.4% (10 patients). Mortality was observed in 4 (66.7%) patients with postoperative PVT. Among 8 patients with Yerdel Grade 3-4 PVT, postoperative PVT occurred in 2 patients (25%). Thrombosis occurred in 2 of 6 patients (33.3%) who underwent graft reconstruction; 1 required reoperation. Portal flow was successfully restored in 83.3% of reconstructed cases. Patients developing postoperative PVT had a higher mean MELD/PELD score (22.5 vs. 19.2), an average age of 48.8 years, and equal gender distribution. The mean follow-up period was 14.2 months overall and 7.7 months in patients with postoperative PVT. Comorbidities (diabetes, hypertension, cardiac, or pulmonary pathology) were present in approximately 50% of patients with postoperative PVT and 62% of those who died. The most common preoperative diagnoses were cryptogenic cirrhosis (22.4%), NASH (18.3%), and HBV infection (16.3%).

Preoperative PVT significantly correlates with postoperative PVT development and mortality following LDLT. Advanced Yerdel stages, high MELD/PELD scores, and the necessity for portal vein reconstruction increase this risk. Early diagnosis, close imaging follow-up, and proper anticoagulation management postoperatively are crucial. Our findings highlight the importance of a multidisciplinary approach in surgical planning and lay the groundwork for prospective, multi-center studies.