Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti · 2011
[Liver transplantation in patients with portal vein thrombosis].
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Janousek L, Adamec M, Oliverius M, Trunecka P, Kucera M
Аннотация
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.
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.