Outcome of Liver Transplantation in the Presence of Portal Vein Thrombosis

Aim: outcomes of Liver Transplantation (LT) in recipients with portal vein thrombosis (PVT). Methods: we reviewed 392 adult patients transplanted between January 2003 and September 2011; 42 (10.7%, group A) had PVT at the time of LT. There were 18 PVT diagnosed prior to LT and 24 intraoperative findings. Results: median follow-up post-LT was 1019 days (range 0-3025). There were no differences between the 2 groups in terms of sex, age, MELD at LT, transplant indication, follow up, ischaemia time, donor's age, donor's sex, donor's days in ICU and graft steatosis. Reconstruction of the PV in group A was done by direct anastomosis (3 patients, 7.1%), thromboendovenectomy + direct anastomosis (34, 80.9%), thromboendovenectomy + interposition graft (2, 4.8%), jump graft (1, 2.4%), anastomosis on a collateral (1, 2.4%); 1 patient died intraoperatively before the PV anastomosis was completed. All patients in group A received i.v. heparin in the immediate post-operative period. In group A 2 patients required haemodialysis post-LT, 1 haemofiltration and mean time on ventilation was of 5 days; in group B (no PVT), 12 patients required haemodialysis (ns), 10 haemofiltration (ns) and mean time on ventilation was 4 days (ns). Mean ICU stay was 10 days in group A, 6 in group B (ns). One recipient (2.4%) in group A and 2 in group B (0.6%, ns) developed hepatic artery thrombosis (HAT); they were retransplanted. There were 2 (4.8%) primary non function (PNF) in group A and 3 (0.9%, ns) in group B. Three patients (7.1%) were retransplanted in group A and 16 (4.6%) in group B (ns). One-year patient survival was 75% vs. 87% (ns) and graft survival 70% vs. 84% (ns) in groups A and B respectively. The 5-year patient survival was 72% vs. 77% (ns) and graft survival 67% vs. 74% (ns). Four patients in group B (1.14%) and 7 in group A (16.6%) developed PVT post-LT. Of the latter 2 were treated with TIPPS, 2 with thrombolysis and stent placement, 1 with prophylactic endoscopic varices ligation, 1 with LMWH, 1 required no treatment. None were listed for re-LT or required further surgery. Conclusion: our experience confirms that the presence of PVT is not a contraindication for LT and survival outcomes are similar to patients without PVT; cases of re-thrombosis can be successfully treated by interventional radiology. An important role can be played by pre-LT diagnosis and planning of surgery.