Portal vein thrombosis during liver transplantation: The risk of extra-anatomical portal vein reconstruction.

BACKGROUND

This study was designed to analyze the risk of extra-anatomical portal vein reconstruction during liver transplantation (LT) in patient with portal vein thrombosis (PVT).

METHODS

Patients who underwent LT between 2008 and 2018 were reviewed. PVT was graded according to the Yerdel system. Risk factor for portal vein complication-free, graft and overall survival were analyzed with multivariate Cox regression.

RESULTS

Seventy out of 1180 patients had PVT. Number of patients who underwent extra-anatomical reconstruction were three (13.0%), three (15.0%), and six (50.0%) with grade II, III and IV thrombosis, respectively. Grade III patients with extra-anatomical reconstruction (HR 10.212, CI 2.475-42.133, P = .001), grade IV with both anatomical (HR 16.991, CI 5.224-54.740, P < .001) and extra-anatomical reconstruction (HR 12.262, CI 2.698-50.666, P = .001) were risk factors for portal vein complication-free survival. Grade IV thrombosis with both anatomical (HR 4.296, CI 1.059-17.430, P = .041) and extra-anatomical reconstruction (HR 7.777, CI 2.461-24.571, P < .001) were risk factors for graft failure. Extra-anatomical reconstruction for both grade I to III (HR 3.638, CI 1.155-11.453, P = .027) and grade IV thrombosis (HR 4.798, CI 1.773-12.982, P = .002) were risk factors for survival.

CONCLUSION

Grade IV thrombosis and extra-anatomical reconstruction were related to poor prognosis. Therefore, thorough evaluation and planning is required for these patients to improve the outcome.