Improved results of liver transplantation in patients with portal vein thrombosis.

OBJECTIVE

To analyze the impact of preexisting portal vein thrombosis (PVT) on the operative management and outcome of liver transplantation.

DESIGN

Retrospective review of 1423 patients who received transplants over 11 years.

SETTING

Tertiary referral center.

PATIENTS OR OTHER

PARTICIPANTS

Seventy patients who underwent liver transplantation who had preexisting PVT.

INTERVENTIONS: Portal vein thromboendovenectomy, vein grafting, or use of portal collateral veins for inflow during liver transplantation.

MAIN OUTCOME MEASURES: Postoperative PVT, intraoperative transfusion, retransplantation rate, 30-day and 1-year actuarial survival rates.

RESULTS

Operative management consisted of thromboendovenectomy in 61 cases, vein graft to the superior mesenteric vein in 6 cases, and vein graft to other mesenteric veins in 3 cases. The incidence of posttransplant PVT was 3% (n = 2). The mean +/- SD transfusion requirement was 23 +/- 18 U. The 1-year actuarial survival rate was 74% but improved from 66% in the first 35 cases to 82% in the latter 35 cases.

CONCLUSIONS

Thromboendovenectomy is the procedure of choice for PVT. Results of liver transplantation in patients with PVT improve significantly with experience gained and are equivalent to results in patients without PVT.