Ovarian Vein to Portal Vein Reconstruction: Another Option in Liver Transplant With Portal Vein Thrombosis.

Portal vein thrombosis is a common complication in patients with cirrhosis and a challenge for the transplant team. Not so long ago, portal vein thrombosis was considered an absolute contraindication for liver transplant, but improvements in surgical techniques have overcome this problem in many transplant centers around the world. Here, we present the case of a 52-year-old female patient with cirrhosis from a primary biliary cholangitis and a complex portal vein thrombosis. She underwent a deceased donor liver transplant with a Model for End-Stage Liver Disease of 40. The portal thrombosis was handled using a portosystemic shunt from the splenic vein to the left ovarian vein, which was visualized on a computed tomography scan performed as part of the study protocol. The donor was a 52-year-old woman with brain death secondary to a vascular cerebral accident. A caval replacement technique was used with no complications during surgery. For the portal anastomosis, the dilated left ovarian vein was carefully dissected and brought through the lesser sac, behind the stomach, to obtain a suitable length. An end-to-end anastomosis of the graft portal vein to the left ovarian vein was performed with a 6-0 Prolene running suture. An abdominal computed tomography scan was performed 6 months after liver transplant showing patency of portal vein and no anastomotic defects, and after 24 months of follow-up the patient is in good clinical condition with normal laboratory values and Doppler ultrasonography with no vascular anomalies and adequate portal flow. To our knowledge, the use of a spleno-ovarian shunt has not been reported as an alternative for portal reconstruction in a case of thrombosis.