Portal vein thrombosis in liver transplantation – Our outcomes and surgical techniques

Abstract

Introduction: Liver transplant is still a surgical challenge mainly in cases of portal venous thrombosis. While some patients listed for liver transplant are preoperatively diagnosed with such condition, others are detected during the transplant surgery. Depending on the extent of thrombosis, there are several portal revascularization techniques. However,results are far from desirable. Purpose: The aim of this article is to report our experience in managing portal vein thrombosis in liver transplant surgery, and to describe alternative surgical techniques for grade III thrombosis. Material and Methods: We assessed 70 liver transplant recipients with portal vein thrombosis who underwent surgery between December 2009 and August 2018. During this period, 847 liver transplants were performed. The surgical technique, postoperative period, recurrence of portal thrombosis and survival were considered for evaluation. Results: The incidence of portal vein thrombosis in transplanted patients during this period of time was 8%. Half of patients were diagnosed along surgery, even though 89% had a doppler or angiogram in the 3 preceding months of the transplant. The majority (40%) had grade I and 21% had grade III thrombosis, according to the Yerdel classification. 87% underwent thrombectomy and direct portal anastomosis. The remaining patients required the use of other surgical techniques that included reconstruction with venous graft, namely the “Y cavo-iliac vein” graft. Conclusions: Portal venous thrombosis is under-diagnosed; nevertheless, it is no longer considered a contraindication for transplantation. There are alternative techniques to solve more extensive portal vein thrombosis with good outcomes.