Transplantation proceedings · 2026
Liver Transplant Outcomes in Patients with Nontumoral Portal Vein Thrombosis: A Decade of Single-Center Experience in Latin America.
СтатьяНазвание и аннотация: Перевод в очереди
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Lizzetti-Mendonza Grecia, Waisberg Daniel Reis, Martino Rodrigo Bronze, Alvarez Jhosimar, Ozelame Ricardo, Pinheiro Rafael Soares, Rocha-Santos Vinícius, Ducatti Liliana, Arantes Rubens Macedo, Santos João Paulo Costa, Alvarez Paola Espinoza, Marin-Castro Pedro, Haddad Luciana Bertocco, Galvão Flavio Henrique, Andraus Wellington
Аннотация
INTRODUCTION: Portal vein thrombosis (PVT) remains a challenging condition in liver transplantation (LT). The impact of reconstruction techniques remains controversial, especially in Latin America. This study aimed to evaluate early and late outcomes of LT in patients with PVT at a high-volume Brazilian center.
METHODS: Retrospective single-center study including adult patients with intraoperatively confirmed PVT undergoing LT between January 2015 and December 2024.
RESULTS: Among 1088 eligible LTs, 207 (19.02%) had PVT. Median recipient age was 59 years, and 68.59% were male. The median MELD-Na score was 17, and MELD exception points were granted to 141 patients. PVT was graded as Yerdel I in 46.85%, II in 27.05%, III in 13.52%, and IV in 12.56% of patients. Anatomical reconstruction was performed in 78.74%. Nonanatomical reconstructions were performed in 44 cases (21.25%), including 16 superior mesenteric vein jump grafts, 12 portal vein anastomoses to enlarged varices, 9 renoportal anastomoses, 5 dual-inflow reconstructions, and 2 portal vein arterialization. Perioperative survival was 86.0%. Independent predictors of decreased 30-day survival were nonanatomical portal reconstruction (P = .04), primary graft nonfunction (P < .01), and higher intraoperative packed red blood cell transfusion (P = .013). Long-term survival was significantly lower in patients requiring nonanatomical reconstruction or postoperative hemodialysis (P < .01). Yerdel grade, MELD score, donor risk index, and graft steatosis were not associated with mortality.
CONCLUSIONS: LT in patients with PVT is feasible with acceptable outcomes. Survival appears to depend more on successful portal inflow reconstruction and perioperative factors than on anatomical PVT extent. Preferential anatomical reconstruction and careful graft selection are critical to optimizing results.
METHODS: Retrospective single-center study including adult patients with intraoperatively confirmed PVT undergoing LT between January 2015 and December 2024.
RESULTS: Among 1088 eligible LTs, 207 (19.02%) had PVT. Median recipient age was 59 years, and 68.59% were male. The median MELD-Na score was 17, and MELD exception points were granted to 141 patients. PVT was graded as Yerdel I in 46.85%, II in 27.05%, III in 13.52%, and IV in 12.56% of patients. Anatomical reconstruction was performed in 78.74%. Nonanatomical reconstructions were performed in 44 cases (21.25%), including 16 superior mesenteric vein jump grafts, 12 portal vein anastomoses to enlarged varices, 9 renoportal anastomoses, 5 dual-inflow reconstructions, and 2 portal vein arterialization. Perioperative survival was 86.0%. Independent predictors of decreased 30-day survival were nonanatomical portal reconstruction (P = .04), primary graft nonfunction (P < .01), and higher intraoperative packed red blood cell transfusion (P = .013). Long-term survival was significantly lower in patients requiring nonanatomical reconstruction or postoperative hemodialysis (P < .01). Yerdel grade, MELD score, donor risk index, and graft steatosis were not associated with mortality.
CONCLUSIONS: LT in patients with PVT is feasible with acceptable outcomes. Survival appears to depend more on successful portal inflow reconstruction and perioperative factors than on anatomical PVT extent. Preferential anatomical reconstruction and careful graft selection are critical to optimizing results.