Zusammenfassung
Die Pfortaderthrombose galt lange Zeit als relative Kontraindikation zur Lebertransplantation. Die intraoperative Diagnose machte aufwendige und risikoreiche chirurgische Maßnahmen nötig, welche mit einer erhöhten Mortalität und Morbidität verbunden waren. Wir präsentieren einen Fallbericht mit intraoperativ diagnostizierter Pfortaderthrombose bei Lebertransplantation und einen risikoärmeren Lösungsansatz in dem eine varikoportale Anastomose durchgeführt wurde. Postoperative Komplikationen waren Ascites und eingeschränkte Nierenfunktion. Der Aszites konnte konservativ therapiert werden und war nach einem Monat rückläufig. Die Nierenfunktion verbesserte sich, eine Dialyse war nicht indiziert. Nach einem halben Jahr hatte der Patient eine normale Leber- und Nierenfunktion.
Summary
The presence of portal vein thrombosis is a potential limitation for liver transplantation. An intraoperative diagnosis is linked to extensive surgical treatment and massive postoperative complications and mortality. We present a surgical less risky method for the treatment of intraoperatively diagnosed portal and mesenteric vein thrombosis that served as salvage therapy for a patient who underwent liver transplantation in our centre. Postoperative complications were ascites and renal failure. Persistent ascites required repeated paracentesis during the first month after liver transplantation but medical treatment sufficed thereafter. Moderate renal failure as defined by the K/DOQI-guidelines improved gradually and dialysis was never indicated. Six months after transplantation, the patient had normal liver function and adequate renal function.
This is a preview of subscription content, log in via an institution to check access.
References
Molmenti EP, Roodhouse TW, Molmenti H, Jaiswal K, Jung G, Marubashi S, et al. Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. Ann Surg 2002;235(2):292–6
Paskonis M, Jurgaitis J, Mehrabi A, Kashfi A, Fonouni H, Strupas K, et al. Surgical strategies for liver transplantation in the case of portal vein thrombosis-current role of cavoportal hemitransposition and renoportal anastomosis. Clin Transplant 2006;20(5):551–62
Tzakis AG, Kirkegaard P, Pinna AD, Jovine E, Misiakos EP, Maziotti A, et al. Liver transplantation with cavoportal hemitransposition in the presence of diffuse portal vein thrombosis. Transplantation 1998;65(5):619–24
Hiatt JR, Quinones-BAldrich WJ, Ramming KP, Lois JF, Busuttil RW. Bile duct varices. An alternative to portoportal anastomosis in liver transplantation. Transplantation 1986;42(1):85
Selvaggi G, Weppler D, Nishida S, Moon J, Levi D, Kato T et al. Ten-Year experience in porto-caval hemitransposition for liver transplantation in the presence of portal vein thrombosis. Am J Transplant 2007;7:454–60
Hiatt JR, Quinones-Baldrich WJ, Ramming KP, Lois JF, Busuttil R. Bile duct varices. An alternative to portoportal anastomosis in liver transplantation. Transplantation 1986;42:85
Patel SS, Kimmel PL, Singh A. New clinical practice guidelines for chronic kidney disease: a framework for K/DOQI. Semin Nephrol 2002;22:449–58
Kniepeiss D, Iberer F, Grasser B, Schaffellner S, Tscheliessnigg KHA single center experience with retrograde reperfusion after liver transplantation. Transpl Int 2003;16:730–5
Ramos AP, Ragada CP, Ataide EC, Almeida JR, Cardoso AR, Caruy CA, Stucci RS, Boin IF. Portal vein thrombosis and liver transplantation: the long term. Transplant Proc 2010;42:489–501
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kniepeiss, D., Müller, H., Wagner, D. et al. Management of complications after varicoportal anastomosis in liver transplantation. Wien Klin Wochenschr 123, 388–389 (2011). https://doi.org/10.1007/s00508-011-1589-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00508-011-1589-0