World Journal of Surgery

, Volume 32, Issue 8, pp 1731–1737

Thrombosis Confined to the Portal Vein Is Not a Contraindication for Living Donor Liver Transplantation

  • Jai Young Cho
  • Kyung-Suk Suh
  • Woo Young Shin
  • Hae Won Lee
  • Nam-Joon Yi
  • Kuhn Uk Lee
Article

Abstract

Background

There is a lack of agreement regarding preexisting portal vein thrombosis (PVT) in patients undergoing living donor liver transplantation (LDLT). We report the results of a single-center study to determine the impact of PVT on outcomes of adult LDLT recipients.

Methods

Of 133 cases of adult LDLT performed between January 2000 and December 2004, a thrombectomy was performed on 22 patients (16.5%) with PVT during the transplant procedure. One hundred eleven patients without PVT (group 1) were compared with those with a thrombosis confined to the portal vein (group 2; n = 15) and patients with the thrombosis beyond the portal vein (group 3; n = 7).

Results

The sensitivities of Doppler ultrasound and CT in detecting PVT were 50 and 63.6%. A prior history of variceal bleeding (OR = 10.6, p = 0.002) and surgical shunt surgery (OR = 28.1, p = 0.044) were found to be an independent risk factors for PVT. The rate of postoperative PVT was significantly higher in patients with PVT than in those without (18.2 vs. 2.7%; p = 0.014). In particular, the rethrombosis rate in group 3 was 28.6%. The actuarial 3-year patient survival rate in PVT patients (73.6%) was similar to that of the non-PVT patients (85.3%; p = 0.351). However, the actuarial 3-year patient survival rate in group 3 was 38.1%, which was significantly lower than that in groups 1 and 2 (p = 0.006).

Conclusion

A thrombosis confined to the portal vein per se should not be considered a contraindication for LDLT.

References

  1. 1.
    Van Thiel DH, Schade RR, Starzl TE et al (1982) Liver transplantation in adults. Hepatology 2:637–640PubMedCrossRefGoogle Scholar
  2. 2.
    Stieber AC, Zetti G, Todo S et al (1991) The spectrum of portal vein thrombosis in liver transplantation. Ann Surg 213:199–206PubMedCrossRefGoogle Scholar
  3. 3.
    Jamieson NV (2000) Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation 69:1772–1774PubMedCrossRefGoogle Scholar
  4. 4.
    Trotter JF (2000) Selection of donors and recipients for living donor liver transplantation. Liver Transpl 6:S52–S58PubMedCrossRefGoogle Scholar
  5. 5.
    Kadry Z, Selzner N, Handschin A et al (2002) Living donor liver transplantation in patients with portal vein thrombosis: a survey and review of technical issues. Transplantation 74:696–701PubMedCrossRefGoogle Scholar
  6. 6.
    Yerdel MA, Gunson B, Mirza D et al (2000) Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation 69:1873–1881PubMedCrossRefGoogle Scholar
  7. 7.
    Seu P, Shackleton CR, Shaked A et al (1996) Improved results of liver transplantation in patients with portal vein thrombosis. Arch Surg 31:840–844, discussion 844–845Google Scholar
  8. 8.
    Manzanet G, Sanjuan F, Orbis P et al (2001) Liver transplantation in patients with portal vein thrombosis. Liver Transpl 7:125–131PubMedCrossRefGoogle Scholar
  9. 9.
    Egawa H, Tanaka K, Kasahara M et al (2006) Single center experience of 39 patients with preoperative portal vein thrombosis among 404 adult living donor liver transplantations. Liver Transpl 12:1512–1518PubMedCrossRefGoogle Scholar
  10. 10.
    Gordon RD (1997) Liver transplantation and venous disorders of the liver. Liver Transpl Surg 3:S41–S51PubMedGoogle Scholar
  11. 11.
    Molmenti EP, Roodhouse TW, Molmenti H et al (2002) Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. Ann Surg 235:292–296PubMedCrossRefGoogle Scholar
  12. 12.
    Davidson BR, Gibson M, Dick R et al (1994) Incidence, risk factors, management, and outcome of portal vein abnormalities at orthotopic liver transplantation. Transplantation 57:1174–1177PubMedCrossRefGoogle Scholar
  13. 13.
    Nonami T, Yokoyama I, Iwatsuki S et al (1992) The incidence of portal vein thrombosis at liver transplantation. Hepatology 16:1195–1198PubMedCrossRefGoogle Scholar
  14. 14.
    Shaked A, Busuttil RW (1991) Liver transplantation in patients with portal vein thrombosis and central portacaval shunts. Ann Surg 214:696–702PubMedCrossRefGoogle Scholar
  15. 15.
    Cherqui D, Duvoux C, Rahmouni A et al (1993) Orthotopic liver transplantation in the presence of partial or total portal vein thrombosis: problems in diagnosis and management. World J Surg 17:669–674PubMedCrossRefGoogle Scholar
  16. 16.
    Langnas AN, Marujo WC, Stratta RJ et al (1992) A selective approach to preexisting portal vein thrombosis in patients undergoing liver transplantation. Am J Surg 163:132–136PubMedCrossRefGoogle Scholar
  17. 17.
    Gayowski TJ, Marino IR, Doyle HR et al (1996) A high incidence of native portal vein thrombosis in veterans undergoing liver transplantation. J Surg Res 60:333–338PubMedCrossRefGoogle Scholar
  18. 18.
    Amitrano L, Brancaccio V, Guardascione MA et al (2000) Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis. Hepatology 31:345–348PubMedCrossRefGoogle Scholar
  19. 19.
    Mahmoud AE, Elias E, Beauchamp N et al (1997) Prevalence of the factor V Leiden mutation in hepatic and portal vein thrombosis. Gut 40:798–800PubMedCrossRefGoogle Scholar
  20. 20.
    Francoz C, Belghiti J, Vilgrain V et al (2005) Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut 54:691–697PubMedCrossRefGoogle Scholar
  21. 21.
    Moreno Gonzalez E, Garcia Garcia I, Gomez Sanz R et al (1993) Liver transplantation in patients with thrombosis of the portal, splenic or superior mesenteric vein. Br J Surg 80:81–85PubMedCrossRefGoogle Scholar
  22. 22.
    Dumortier J, Czyglik O, Poncet G et al (2002) Eversion thrombectomy for portal vein thrombosis during liver transplantation. Am J Transplant 2:934–938PubMedCrossRefGoogle Scholar
  23. 23.
    Gaiani S, Bolondi L, Li Bassi S et al (1991) Prevalence of spontaneous hepatofugal portal flow in liver cirrhosis. Clinical and endoscopic correlation in 228 patients. Gastroenterology 100:160–167Google Scholar
  24. 24.
    Taourel P, Blanc P, Dauzat M et al (1998) Doppler study of mesenteric, hepatic, and portal circulation in alcoholic cirrhosis: relationship between quantitative Doppler measurements and the severity of portal hypertension and hepatic failure. Hepatology 28:932–936PubMedCrossRefGoogle Scholar
  25. 25.
    Cakmak O, Elmas N, Tamsel S et al (2008) Role of contrast-enhanced 3D magnetic resonance portography in evaluating portal venous system compared with color Doppler ultrasonography. Abdom Imaging 33:65–71PubMedCrossRefGoogle Scholar
  26. 26.
    Stafford-Johnson DB, Hamilton BH, Dong Q et al (1998) Vascular complications of liver transplantation: evaluation with gadolinium-enhanced MR angiography. Radiology 207:153–160PubMedGoogle Scholar
  27. 27.
    Kok T, Slooff MJ, Thijn CJ et al (1998) Routine Doppler ultrasound for the detection of clinically unsuspected vascular complications in the early postoperative phase after orthotopic liver transplantation. Transpl Int 11:272–276PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Jai Young Cho
    • 1
  • Kyung-Suk Suh
    • 1
  • Woo Young Shin
    • 1
  • Hae Won Lee
    • 1
  • Nam-Joon Yi
    • 1
  • Kuhn Uk Lee
    • 1
  1. 1.Department of SurgerySeoul National University College of Medicine, Seoul National University HospitalChongno-gu, SeoulKorea

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