Liver transplantation in the presence of portal vein thrombosis: report of 21 cases

Objective To investigate the surgical options in patients with portal vein thrombosis (PVT) in liver transplantation (LTx) and to assess the impact of PVT on LTx outcome.Methods The clinical data of 270 LTx performed for 267 end-stage liver disease patients were retrospectively analyzed. Twenty-one cases ( 7.8 %) presented with PVT during transplantation. Twelve of 21 cases of PVT were identified by Doppler color ultrasound, computered tomography angiography or magnetic resonance imagine before LTx. PVT was retrospectively graded according to Yerdel’s manner: 8 cases of grade 1, 5 cases of grade 2, 6 cases of grade 3, and 2 cases of grade 4. The management of PVT depended mainly on Yerdel's grading: Grade 1 and 2 PVT was managed by simple thrombectomy and/or dissection of PVT portal trunk segment; In grade 3 and grade 4, the distal superior mesentery vein (SMV) or a splanchnic collateral tributary was directly used as an inflow vessel through an interposition donor iliac vein or SMV. Results LTx was successfully performed on all 21 patients presented with PVT. Four patients with grade 3 PVT died perioperatively with a significant higher mortality rate ( 19.0 %) than that of non-PVT group ( 8.5 %) (P 0.01). Post-LTx PVT occurred in 1/21 ( 4.8 %) of the PVT group versus 2/246 ( 0.8 %) in the non-PVT group (P 0.01). There were no significant differences in actuarial 1-year patient survival rate between the 17 PVT patients ( 94.1 %) and non-PVT group ( 93.8 %)(P 0.05).Conclusions PVT is not Absolute contraindication for LTx. The ideal treatment for PVT during liver transplantation depends on its Yerdel’s grading. The same long-term LTx survival results can be achieved in PVT patients as in non-PVT patients.