Management of Non-neoplastic Portal Vein Thrombosis in Adult Living Donor Liver Transplantation

Nontumoral portal vein thrombosis (PVT) refers to thrombotic occlusion of the PV, affecting both superior mesenteric vein (SMV) and splenic vein owing to portal hypertension in cirrhotic patients. Nontumoral PVT is more frequent in cirrhotic patients with a prevalence ranging from 10-14% to 25%.

We evaluated the prevalence, morbidity (rethrombosis, ascites), mortality survival rates and contributing factors in patients with PVT (preoperative/perioperative) who underwent PV thromboendovenectomy.

We performed 522 living donor liver transplantations between November 2021 and 2024; 82 patients (46 male/36 female) had non-neoplastic chronic cruoric PVT. The prevalence of PVT is 15.7%. Forty-four patients were classified as Yerdel I, 19 as Yerdel II, and 19 as Yerdel III; 53 patients (65%) had a Model for End-Stage Liver Disease (MELD) score of <15. Rethrombosis was seen in 4 cases (4.87%) and 2 patients died. Twelve mortalities were seen (14.63 %). Two of the 12 deaths were related to rethrombosis.

Our mortality rates were similar in patients with and without PVT, and PVT had no impact on mortality. When chronic PVT is detected, transplantation should not be delayed, even if the MELD score is low, because PVT can progress faster than MELD, ultimately increasing mortality.