When and why portal vein thrombosis matters in liver transplantation: A critical audit of 174 cases

Taizo Hibi, Seigo Nishida, David M. Levi, Gennaro Selvaggi, Akin Tekin, Ji Fan, Phillip Ruiz, Andreas G. Tzakis

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE:: To identify complications associated with different techniques utilized to treat portal vein thrombosis (PVT) during primary liver transplantation and their impact on survival. BACKGROUND:: PVT remains an intricate problem in liver transplantation, and the long-term outcomes of patients with PVT who undergo transplantation are not well defined. METHODS:: We performed a retrospective cohort analysis of all consecutive adult patients who underwent primary isolated liver transplantation from 1998 to 2009 (median follow-up period, 89 months). The outcomes of patients with PVT were compared with those without PVT. RESULTS:: Among 1379 recipients, 174 (12.6%) had PVT at the time of transplantation [83 (48%) complete and 91 (52%) partial]. Among PVT patients with reestablished physiological portal inflow (PVT: physiological group; n = 149), 123 underwent thrombectomies, 16 received interpositional vein grafts, and 10 received mesoportal jump grafts. In 25 patients, physiological portomesenteric venous circulation was not reconstituted (PVT: nonphysiological group; 18 underwent cavoportal hemitranspositions, 6 renoportal anastomoses, and 1 arterialization). The PVT: nonphysiological group suffered a significantly increased incidence of rethrombosis of the portomesenteric veins and gastrointestinal bleeding, with a marginal 10-year overall survival rate of 42% (no PVT, 61%; P = 0.002 and PVT: physiological, 55%; P = 0.043). The PVT: physiological and no PVT groups exhibited comparable survival rates (P = 0.13). No significant differences in survival were observed between complete and partial PVT as long as physiological portal flow was reestablished. CONCLUSIONS:: The subset of PVT patients requiring nonphysiological portal vein reconstruction was associated with higher complication rates and suffered diminished long-term prognoses. For the most severe PVT cases, a comprehensive approach is critical to further improve outcomes.

Original languageEnglish
Pages (from-to)760-766
Number of pages7
JournalAnnals of Surgery
Volume259
Issue number4
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Portal Vein
Liver Transplantation
Thrombosis
Veins
Survival Rate
Transplantation
Transplants
Thrombectomy
Survival

Keywords

  • Cavoportal hemitransposition
  • liver transplantation
  • mesoportal jump graft
  • portal vein thrombosis
  • renoportal anastomosis

ASJC Scopus subject areas

  • Surgery

Cite this

Hibi, T., Nishida, S., Levi, D. M., Selvaggi, G., Tekin, A., Fan, J., ... Tzakis, A. G. (2014). When and why portal vein thrombosis matters in liver transplantation: A critical audit of 174 cases. Annals of Surgery, 259(4), 760-766. https://doi.org/10.1097/SLA.0000000000000252

When and why portal vein thrombosis matters in liver transplantation : A critical audit of 174 cases. / Hibi, Taizo; Nishida, Seigo; Levi, David M.; Selvaggi, Gennaro; Tekin, Akin; Fan, Ji; Ruiz, Phillip; Tzakis, Andreas G.

In: Annals of Surgery, Vol. 259, No. 4, 2014, p. 760-766.

Research output: Contribution to journalArticle

Hibi, T, Nishida, S, Levi, DM, Selvaggi, G, Tekin, A, Fan, J, Ruiz, P & Tzakis, AG 2014, 'When and why portal vein thrombosis matters in liver transplantation: A critical audit of 174 cases', Annals of Surgery, vol. 259, no. 4, pp. 760-766. https://doi.org/10.1097/SLA.0000000000000252
Hibi, Taizo ; Nishida, Seigo ; Levi, David M. ; Selvaggi, Gennaro ; Tekin, Akin ; Fan, Ji ; Ruiz, Phillip ; Tzakis, Andreas G. / When and why portal vein thrombosis matters in liver transplantation : A critical audit of 174 cases. In: Annals of Surgery. 2014 ; Vol. 259, No. 4. pp. 760-766.
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abstract = "OBJECTIVE:: To identify complications associated with different techniques utilized to treat portal vein thrombosis (PVT) during primary liver transplantation and their impact on survival. BACKGROUND:: PVT remains an intricate problem in liver transplantation, and the long-term outcomes of patients with PVT who undergo transplantation are not well defined. METHODS:: We performed a retrospective cohort analysis of all consecutive adult patients who underwent primary isolated liver transplantation from 1998 to 2009 (median follow-up period, 89 months). The outcomes of patients with PVT were compared with those without PVT. RESULTS:: Among 1379 recipients, 174 (12.6{\%}) had PVT at the time of transplantation [83 (48{\%}) complete and 91 (52{\%}) partial]. Among PVT patients with reestablished physiological portal inflow (PVT: physiological group; n = 149), 123 underwent thrombectomies, 16 received interpositional vein grafts, and 10 received mesoportal jump grafts. In 25 patients, physiological portomesenteric venous circulation was not reconstituted (PVT: nonphysiological group; 18 underwent cavoportal hemitranspositions, 6 renoportal anastomoses, and 1 arterialization). The PVT: nonphysiological group suffered a significantly increased incidence of rethrombosis of the portomesenteric veins and gastrointestinal bleeding, with a marginal 10-year overall survival rate of 42{\%} (no PVT, 61{\%}; P = 0.002 and PVT: physiological, 55{\%}; P = 0.043). The PVT: physiological and no PVT groups exhibited comparable survival rates (P = 0.13). No significant differences in survival were observed between complete and partial PVT as long as physiological portal flow was reestablished. CONCLUSIONS:: The subset of PVT patients requiring nonphysiological portal vein reconstruction was associated with higher complication rates and suffered diminished long-term prognoses. For the most severe PVT cases, a comprehensive approach is critical to further improve outcomes.",
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T1 - When and why portal vein thrombosis matters in liver transplantation

T2 - A critical audit of 174 cases

AU - Hibi, Taizo

AU - Nishida, Seigo

AU - Levi, David M.

AU - Selvaggi, Gennaro

AU - Tekin, Akin

AU - Fan, Ji

AU - Ruiz, Phillip

AU - Tzakis, Andreas G.

PY - 2014

Y1 - 2014

N2 - OBJECTIVE:: To identify complications associated with different techniques utilized to treat portal vein thrombosis (PVT) during primary liver transplantation and their impact on survival. BACKGROUND:: PVT remains an intricate problem in liver transplantation, and the long-term outcomes of patients with PVT who undergo transplantation are not well defined. METHODS:: We performed a retrospective cohort analysis of all consecutive adult patients who underwent primary isolated liver transplantation from 1998 to 2009 (median follow-up period, 89 months). The outcomes of patients with PVT were compared with those without PVT. RESULTS:: Among 1379 recipients, 174 (12.6%) had PVT at the time of transplantation [83 (48%) complete and 91 (52%) partial]. Among PVT patients with reestablished physiological portal inflow (PVT: physiological group; n = 149), 123 underwent thrombectomies, 16 received interpositional vein grafts, and 10 received mesoportal jump grafts. In 25 patients, physiological portomesenteric venous circulation was not reconstituted (PVT: nonphysiological group; 18 underwent cavoportal hemitranspositions, 6 renoportal anastomoses, and 1 arterialization). The PVT: nonphysiological group suffered a significantly increased incidence of rethrombosis of the portomesenteric veins and gastrointestinal bleeding, with a marginal 10-year overall survival rate of 42% (no PVT, 61%; P = 0.002 and PVT: physiological, 55%; P = 0.043). The PVT: physiological and no PVT groups exhibited comparable survival rates (P = 0.13). No significant differences in survival were observed between complete and partial PVT as long as physiological portal flow was reestablished. CONCLUSIONS:: The subset of PVT patients requiring nonphysiological portal vein reconstruction was associated with higher complication rates and suffered diminished long-term prognoses. For the most severe PVT cases, a comprehensive approach is critical to further improve outcomes.

AB - OBJECTIVE:: To identify complications associated with different techniques utilized to treat portal vein thrombosis (PVT) during primary liver transplantation and their impact on survival. BACKGROUND:: PVT remains an intricate problem in liver transplantation, and the long-term outcomes of patients with PVT who undergo transplantation are not well defined. METHODS:: We performed a retrospective cohort analysis of all consecutive adult patients who underwent primary isolated liver transplantation from 1998 to 2009 (median follow-up period, 89 months). The outcomes of patients with PVT were compared with those without PVT. RESULTS:: Among 1379 recipients, 174 (12.6%) had PVT at the time of transplantation [83 (48%) complete and 91 (52%) partial]. Among PVT patients with reestablished physiological portal inflow (PVT: physiological group; n = 149), 123 underwent thrombectomies, 16 received interpositional vein grafts, and 10 received mesoportal jump grafts. In 25 patients, physiological portomesenteric venous circulation was not reconstituted (PVT: nonphysiological group; 18 underwent cavoportal hemitranspositions, 6 renoportal anastomoses, and 1 arterialization). The PVT: nonphysiological group suffered a significantly increased incidence of rethrombosis of the portomesenteric veins and gastrointestinal bleeding, with a marginal 10-year overall survival rate of 42% (no PVT, 61%; P = 0.002 and PVT: physiological, 55%; P = 0.043). The PVT: physiological and no PVT groups exhibited comparable survival rates (P = 0.13). No significant differences in survival were observed between complete and partial PVT as long as physiological portal flow was reestablished. CONCLUSIONS:: The subset of PVT patients requiring nonphysiological portal vein reconstruction was associated with higher complication rates and suffered diminished long-term prognoses. For the most severe PVT cases, a comprehensive approach is critical to further improve outcomes.

KW - Cavoportal hemitransposition

KW - liver transplantation

KW - mesoportal jump graft

KW - portal vein thrombosis

KW - renoportal anastomosis

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