#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Liver Transplantation in Patients with Portal Vein Thrombosis


Authors: L. Janoušek;  M. Adamec;  M. Oliverius;  P. Trunečka *;  M. Kučera
Authors‘ workplace: Klinika transplantační chirurgie, IKEM, přednosta prof. MUDr. Miloš Adamec, CSc. ;  Transplantcentrum IKEM, přednosta: prof. MUDr. Pavel Trunečka, CSc. *
Published in: Rozhl. Chir., 2011, roč. 90, č. 2, s. 114-116.
Category: Monothematic special - Original

Overview

Aim:
The aim of the study was to perform a retrospective assessment in a group of patients with portal vein thromboses who underwent consecutive liver transplantation.

Material and Methods:
PVT was preoperatively diagnosed with ultrasound and CT portography. The follow up period was 1 to 6 years. Postoperative immunosuppressive medication was administered in combination with cyclosporin A, prednison and imuran upon initiation of the transplantation programme (8 patients). During the follow up period, the treatment protocol was replaced with FK 506, Cell Cept and prednisone. Liver biopsy was indicated when rejection was suspected.

Results:
During 1996–2009, the team of authors performed a total of 740 liver transplantations in 303 female and 437 male subjects. The procedures included 703 primary procedures, 33 retransplantations and four second retransplantations. Out of the total, 57 recipients (7.7 %) had portal vein obliteration. These subjects included 42 male and 15 females, their mean age was 52 (9–67) years. 62 liver transplantations were performed in these 57 patients. The following complications were recorded in the patient group: graft dysfunction in 10.5%, revisions for bleeding in 28%, hepatic artery thrombosis in 10.5%, portal vein rethrombosis in 1.8%, biliary complications in 17.5%, acute rejections in 19.3 %. Perioperative mortality rate was 15.8%. The mean blood derivates requirement was 17.1 (0–425) erythrocyte transfusion units, 27.1 (0–132) frozen plasma transfusion units and 2.6 (0–20) thrombocyte transfusion units.

Conclusion:
The results of out retrospective study indicate that portal thrombosis is not a contraindication for liver transplantation. Current surgical techniques make liver transplantations in patients with complete splanchnic venous thrombosis possible.

Key words:
v. portae – thrombosis – liver transplantation


Sources

1. van Thiel, D. H. S. R., Starzl, T. E. Liver transplantation in patients with portal vein thrombosis. Hepatology, 1982: 637.

2. Stieber, A. C., Zetti, G., Todo, S., et al. The spectrum of portal vein thrombosis in liver transplantation. Ann. Surg., 1991; 213: 199–206.

3. Seu, P., Shackleton, C. R., Shaked, A., et al. Improved results of liver transplantation in patients with portal vein thrombosis. Arch. Surg., 1996; 131: 840–844; discussion 844–845.

4. Molmenti, E. P., Roodhouse, T. W., Molmenti, H., et al. ­Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. Ann. Surg., 2002; 235: 292–296.

5. Dumortier, J., Czyglik, O., Poncet, G., et al. Eversion thrombectomy for portal vein thrombosis during liver transplantation. Am. J. Transplant., 2002; 2: 934–938.

6. Janssen, H. L. M. J., Vleggaar, F. P. Factor V Leiden mutation, prothrombin gene mutation and definciensis in coagulation inhibitors associated with Budd-Chiari syndrome and portal vein ­thrombosis: Results of a case-control study. Blood Coagul. Fibrinolysis, 2000: 2364–2368.

7. Francoz, C., Belghiti, J., Vilgrain, V., et al. Splanchnic vein ­thrombosis in candidates for liver transplantation: usefulness of ­screening and anticoagulation. Gut, 2005; 54: 691–697.

8. Carr, B. I. B. S., Kondragunta, V., Pancoska, P., Branch, R. A. Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a case cohort study. J. Gastroenterol. Hepatol., 2008; 23: 1259–1266.

9. Yerdel, M. A., Gunson, B., Mirza, D., et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation, 2000; 69: 1873–1881.

10. Englesbe, M. J., Schaubel, D. E., Cai, S., Guidinger, M. K., Merion, R. M. Portal vein thrombosis and liver transplant survival benefit. Liver Transpl., 16: 999–1005.

11. Manzanet, G., Sanjuan, F., Orbis, P., et al. Liver transplanta­tion in patients with portal vein thrombosis. Liver Transpl., 2001; 7: 125–131.

12. Shaw, B. W. I. S., Bron, K., Starzl, T. E. Portal vein grafts in hepatic transplantation. Surg. Gynecol. Obstet, 1985: 66–68.

13. Langnas, A. N., Marujo, W. C., Stratta, R. J., et al. A selective approach to preexisting portal vein thrombosis in patients undergoing liver transplantation. Am. J. Surg., 1992; 163: 132–136.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#