Translational gastroenterology and hepatology · 2026
Ectopic physiological portal vein reconstruction in liver transplantation for benign portal vein thrombosis.
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Song Jiyong, Wu Guangdong, Yu Lihan, Tong Xuan, Li Ang, Li Ziqiang, Lin Jingyi, Fan Tieyan, Tang Rui, Xu Guangxun, Lu Qian
Аннотация
BACKGROUND: Benign portal vein thrombosis (PVT) presents considerable technical challenges for portal vein reconstruction (PVR) during liver transplantation (LT). This study aimed to evaluate the surgical outcomes, safety profile, and clinical feasibility of ectopic physiological portal vein reconstruction (EPPVR) at non-hilar area for patients with complex benign PVT.
METHODS: We conducted a retrospective observational cohort study analyzing intraoperative parameters, postoperative complications, and survival outcomes in liver transplant recipients with benign PVT. Among 120 enrolled patients, 10 cases (8.3%) underwent EPPVR, including three varicose vein reconstructions (VVRs), one anterior transpancreatic bridge reconstruction, and five "pull-out" portal vein reconstructions (POPVRs) beneath the pancreas.
RESULTS: Compared with conventional orthotopic physiological portal vein reconstruction (OPPVR), EPPVR was associated with significantly longer anhepatic phase (154.50±45.43 vs. 79.77±34.56 mins, P<0.001) and greater intraoperative blood loss (1,930.00±1,515.15 vs. 766.36±707.50 mL, P=0.001). Postoperatively, the EPPVR group demonstrated markedly higher rates of elevated ascitic fluid amylase (60.0% vs. 5.5%, P<0.001) and required more frequent portal vein stent implantation in surviving patients (37.5% vs. 3.9%, P=0.008). Other complication rates and perioperative survival rate were comparable between these two groups. The above trends remained consistent in the subgroup analysis of patients with Yerdel grade 2-4 PVT, although the difference in stent implantation rates lost statistical significance (37.5% vs. 10.3%, P=0.15).
CONCLUSIONS: Although EPPVR was associated with elevated perioperative risks, it did not decrease the perioperative survival rate in PVT patients. This reconstruction approach may represent a feasible alternative for complex PVT cases requiring non-standard reconstruction approaches, contingent upon thorough preoperative assessment and surgical planning.
METHODS: We conducted a retrospective observational cohort study analyzing intraoperative parameters, postoperative complications, and survival outcomes in liver transplant recipients with benign PVT. Among 120 enrolled patients, 10 cases (8.3%) underwent EPPVR, including three varicose vein reconstructions (VVRs), one anterior transpancreatic bridge reconstruction, and five "pull-out" portal vein reconstructions (POPVRs) beneath the pancreas.
RESULTS: Compared with conventional orthotopic physiological portal vein reconstruction (OPPVR), EPPVR was associated with significantly longer anhepatic phase (154.50±45.43 vs. 79.77±34.56 mins, P<0.001) and greater intraoperative blood loss (1,930.00±1,515.15 vs. 766.36±707.50 mL, P=0.001). Postoperatively, the EPPVR group demonstrated markedly higher rates of elevated ascitic fluid amylase (60.0% vs. 5.5%, P<0.001) and required more frequent portal vein stent implantation in surviving patients (37.5% vs. 3.9%, P=0.008). Other complication rates and perioperative survival rate were comparable between these two groups. The above trends remained consistent in the subgroup analysis of patients with Yerdel grade 2-4 PVT, although the difference in stent implantation rates lost statistical significance (37.5% vs. 10.3%, P=0.15).
CONCLUSIONS: Although EPPVR was associated with elevated perioperative risks, it did not decrease the perioperative survival rate in PVT patients. This reconstruction approach may represent a feasible alternative for complex PVT cases requiring non-standard reconstruction approaches, contingent upon thorough preoperative assessment and surgical planning.