Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality

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Clinical Transplantation

Volume 21 Issue 6 Page 716-721, November/December 2007

To cite this article: Lladó, Fabregat, José Castellote, Emilio Ramos, Jaume Torras, Jorba, Francisco -Borobia, Juli Busquets, Figueras, Antoni Rafecas (2007) Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality Clinical Transplantation 21 (6), 716–721. doi:10.1111/j.1399-0012.2007.00728.x

Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality

Department of aSurgery and bGastroenterology, Liver Transplant Unit, H. U. Bellvitge, University of Barcelona, Barcelona, Spain

Dr. Lladó, Department of Surgery, Liver Transplant Unit, Hospital. U. de Bellvitge, C/Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain.Tel.: 34 93 260 7940; fax: 34 93 260 7603;e-mail: 31513llg@...

Lladó L, Fabregat J, Castellote J, Ramos E, Torras J, Jorba R, -Borobia F, Busquets J, Figueras J, Rafecas A. Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality.Clin Transplant 2007: 21: 716–721. © Blackwell Munksgaard, 2007

Abstract

Background: Splanchnic thrombosis is a surgical challenge in liver transplantation (LT). The aim of this study was to analyze our experience in the management of portal vein thrombosis, and its influence on evolution.

Aim: The aim of this study was to analyze our experience in the management of portal vein thrombosis, and its influence on evolution.

Patients and methods: Between 1999 and 2004, 366 liver transplants were performed in 335 patients. Forty-two patients [12.5%: portal vein thrombosis (PVT) group] had portal thrombosis at the time of LT. We analyzed the technical aspects and compared their evolution with a group of patients without portal thrombosis (n = 293; no-PVT group). Retransplantations were excluded.

Results: Of the 42 patients with thrombosis, 18 had partial thrombosis and 16 complete thrombosis [six included the proximal superior mesenteric vein (SMV) and in two the whole splanchnic system]. In 12 cases, usual T-T anastomosis was performed and in 16 cases a thrombectomy was carried out; there were five cases of anastomosis at confluence of the SMV, five cases of anastomosis to a collateral vein, three cases of venous graft, and one case of cavoportal hemitransposition. The operative time was higher in PVT group (417 ± 103 min vs. 363 ± 83; p = 0.0005), as RBC transfusion (2.4 ± 3.1 vs. 1.9 ± 2.3; p = 0.04), and hospital stay (20.9 ± 14.9 d vs. 15.1 ± 10.6; p = 0.002). However, there were no differences in hospital mortality (4% vs. 7.8%; p = 0.98), primary dysfunction (4.8% vs. 7.8%; p = 0.44), or three-yr-actuarial survival (75% vs. 77%; p = 0.95). The incidence of post-transplant thrombosis was higher in the PVT group (15% vs. 2.4%; p = 0.0005).

Conclusions: Portal thrombosis is associated with greater operative complexity and rethrombosis, but has no influence on overall morbidity and mortality.