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Physiological reno-portal bypass in liver transplantation with non-tumorous portal vein thrombosis

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Abstract

Reno-portal anastomosis (RPA) in presence of spleno-renal shunts (SRS) is a physiological option to restore blood flow in liver transplantation with portal vein thrombosis (PVT). Diffuse splanchnic venous system thrombosis (complex PVT) is its main indication but RPA proved to be useful in selected cases of less extensive thrombosis (non-complex PVT). Up until now only two monocentric and one multicentric case series has been published on this topic in addition to few anecdotal reports. After 2014, we introduced RPA in our institution to manage some cases of complex PVT in presence of SRS. Here, we present the evolution of indication to RPA. From 2014 to 2020, we performed ten RPA: nine patients presented non-complex and one complex PVT. Overall early and late complication rates were 66.6% and 50%, respectively. Two patients developed RPA stenosis, treated by interventional radiology. Self-resolving acute kidney injury (AKI) was observed in three cases. No re-transplantation was necessary. RPA was patent in all patients, with a mean follow-up of 41.9 months. The overall patient survival was 70% at 1 year and 60% at 3 and 5 years. Four patients died at 1, 2, 3 and 20 months from LT. Causes of deaths were, respectively, stroke, cerebral infection, sepsis (MOF) and sudden variceal bleeding in sinusoidal obstruction syndrome. The relative simplicity and effectiveness of RPA in presence of SRS allowed us to rely more and more often on this technique in liver transplantation with challenging non-complex PVT.

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References

  1. Zanetto A, Rodriguez-Kastro KI, Germani G, Ferrarese A, Cillo U, Burra P, Senzolo M (2018) Mortality in liver transplant recipients with portal vein thrombosis—an updated meta-analysis. Transpl Int 31(12):1318–1329

    Article  Google Scholar 

  2. Ghabril M, Agarwal S, Lacerda M, Chalasani N, Kwo P, Tector AJ (2016) Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation 100(1):126–133

    Article  CAS  Google Scholar 

  3. Rodríguez-Castro KI, Porte RJ, Nadal E, Germani G, Burra P, Senzolo M (2012) Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation 94(11):1145–1153

    Article  Google Scholar 

  4. Yerdel MA, Gunson B, Mirza D, Karayalcin K, Olliff S, Buckels J, Mayer D, McMaster P, Pirenne J (2000) Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation 69(9):1873–1881

    Article  CAS  Google Scholar 

  5. Bhangui P, Lim C, Levesque E, Salloum C, Lahat E, Feray C, Azoulay D (2019) Novel classification of non-malignant portal vein thrombosis: a guide to surgical decision-making during liver transplantation. J Hepatol 71(5):1038–1050

    Article  Google Scholar 

  6. Tzakis AG, Kirkegaard P, Pinna AD, Jovine E, Misiakos EP, Maziotti A, Dodson F, Khan F, Nery J, Rasmussen A, Fung JJ, Demetris A, Ruiz PJ (1998) Liver transplantation with cavoportal hemitransposition in the presence of diffuse portal vein thrombosis. Transplantation 65(5):619–624

    Article  CAS  Google Scholar 

  7. Bhangui P, Lim C, Salloum C, Andreani P, Sebbagh M, Hoti E, Ichai P, Saliba F, Adam R, Castaing D, Azoulay D (2011) Caval inflow to the graft for liver transplantation in patients with diffuse portal vein thrombosis: a 12-year experience. Ann Surg 254(6):1008–1016

    Article  Google Scholar 

  8. D’Amico G, Hassan A, Diago Uso T, Hashimoto K, Aucejo FN, Fujiki M, Eghtesad B, Sasaki K, Lindenmeyer CC, Miller CM, Quintini C (2019) Renoportal anastomosis in liver transplantation and its impact on patient outcomes: a systematic literature review. Transpl Int 32(2):117–127

    Article  Google Scholar 

  9. Jamieson NV (2000) Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation 69(9):1772–1774

    Article  CAS  Google Scholar 

  10. Charco R, Fuster J, Fondevila C, Ferrer J, Mans E, García-Valdecasas JC (2005) Portal vein thrombosis in liver transplantation. Transplant Proc 37(9):3904–3905

    Article  CAS  Google Scholar 

  11. Sheil AG, Stephen MS, Chui AK, Ling J, Bookallil MJ (1997) A liver transplantation technique in a patient with a thrombosed portal vein and a functioning renal-lieno shunt. Clin Transplant 11:71–73

    CAS  PubMed  Google Scholar 

  12. McKenna GJ (2015) Making the extraordinary, ordinary: renoportal bypass for complete portal vein thrombosis. Liver Transpl 21(3):275–276

    Article  Google Scholar 

  13. Azoulay D, Quintini C, Rayar M, Salloum C, Llado L, Diago T, D’Amico G, Ramos E, Fabregat J, Eshkenazy R, Bardou-Jacquet E, Camus C, Compagnon P, Vibert E, Lim C (2021) Renoportal anastomosis during liver transplantation in patients with portal vein thrombosis: first long-term results from a multicenter study. Ann Surg. https://doi.org/10.1097/SLA.0000000000004797

    Article  PubMed  Google Scholar 

  14. Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, Shaked A, Christie JD (2010) Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl 16(8):943–949

    Article  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  16. Ikegami T, Yoshizumi T, Tsutsui Y, Harada N, Itoh S, Yoshiya S, Imai D, Uchiyama H, Mori M (2019) Extensive thrombectomy as a legitimate strategy in living donor liver transplantation with advanced portal vein thrombosis. Liver Transpl 25:1768–1777

    Article  Google Scholar 

  17. Sharshar M, Yagi S, Iida T, Yoa S, Miyachi Y, Macshut M, Iwamura S, Hirata M, Ito T, Hata K, Taura K, Okajima H, Kaido T, Uemoto S (2020) Liver transplantation in patients with portal vein thrombosis: a strategic road map throughout management. Surgery 168:1160–1168

    Article  Google Scholar 

  18. Nazzal M, Sun Y, Okoye O, Diggs L, Evans N, Osborn T, Etesami K, Varma C (2017) Reno-portal shunt for liver transplant, an alternative inflow for recipients with grade III–IV portal vein thrombosis: tips for a better outcome. Int J Surg Case Rep 41:251–254

    Article  Google Scholar 

  19. Bhangui P, Fernandes ES, Di Benedetto F, Joo DJ, Nadalin S (2020) Current management of portal vein thrombosis in liver transplantation. Int J Surg 82:122–127

    Article  Google Scholar 

  20. Quintini C, Spaggiari M, Hashimoto K, Aucejo F, Diago T, Fujiki M, Winans C, D’Amico G, Trenti L, Kelly D, Eghtesad B, Miller C (2015) Safety and effectiveness of renoportal bypass in patients with complete portal vein thrombosis: an analysis of 10 patients. Liver Transpl 21(3):344–352

    Article  Google Scholar 

  21. Rhu J, Choi GS, Kwon CHD, Kim JM, Joh JW (2020) Portal vein thrombosis during liver transplantation: the risk of extra-anatomical portal vein reconstruction. J Hepatobiliary Pancreat Sci 27:242–253

    Article  Google Scholar 

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Authors and Affiliations

  1. General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy

    Domenico Pinelli, Flavia Neri, Stefania Tornese, Annalisa Amaduzzi, Stefania Camagni & Michele Colledan

  2. Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy

    Lorenzo D’Antiga

  3. Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy

    Stefano Fagiuoli

  4. Università di Milano - Bicocca, Piazza dell′Ateneo Nuovo, 1, 20126, Milano, MI, Italy

    Michele Colledan

Authors
  1. Domenico Pinelli
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  2. Flavia Neri
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  3. Stefania Tornese
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  4. Annalisa Amaduzzi
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  5. Stefania Camagni
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  6. Lorenzo D’Antiga
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  7. Stefano Fagiuoli
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  8. Michele Colledan
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Contributions

DP and MC designed the study. DP, ST and FN wrote the paper. ST and AA collected data. SC analyzed data. LD and SF reviewed the paper.

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Correspondence to Domenico Pinelli.

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The authors did not receive any funding to assist with the preparation of this manuscript. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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We certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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All patients included in the study signed an informed consent on the anonymous use of their clinical data for research purposes.

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Pinelli, D., Neri, F., Tornese, S. et al. Physiological reno-portal bypass in liver transplantation with non-tumorous portal vein thrombosis. Updates Surg 74, 1617–1626 (2022). https://doi.org/10.1007/s13304-022-01280-y

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  • DOI: https://doi.org/10.1007/s13304-022-01280-y

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