Outcomes of Surgical Strategies for Living Donor Liver Transplantation in Patients With Portal Vein Thrombosis: A Cohort Study.

Autor: Kirimker EO; Department of Surgery, Ankara University School of Medicine, Ankara, Turkey. Electronic address: kirimker@ankara.edu.tr., Kabacam G; Department of Gastroenterology, Ankara Guven Hastanesi, Ankara, Turkey., Keskin O; Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey., Goktug UU; Department of Surgery, Ministry of Health Kecioren Training and Research Hospital, Ankara, Turkey., Atli M; Department of Surgery, Ankara Guven Hastanesi, Ankara, Turkey., Bingol-Kologlu M; Department of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey., Karayalcin K; Department of Surgery, Ankara University School of Medicine, Ankara, Turkey., Karademir S; Department of Surgery, Ankara Guven Hastanesi, Ankara, Turkey., Balci D; Department of Surgery, Ankara University School of Medicine, Ankara, Turkey.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2022 Oct; Vol. 54 (8), pp. 2217-2223. Date of Electronic Publication: 2022 Sep 01.
DOI: 10.1016/j.transproceed.2022.07.006
Abstrakt: Background: Adequate portal flow to the liver graft is the requirement of a successful liver transplant (LT). Historically, portal vein thrombosis (PVT) was a contraindication for LT, especially for living donor LT (LDLT), demanding technically more difficult operations and advanced technique. In this study, the outcomes of patients with and without PVT after LDLT were compared.
Methods: Adult LDLTs performed by 2 centers (n = 335) between 2013 and 2020 were included into this large cohort study. PVT was classified based on Yerdel classification grade 1 to 4.
Results: Sixty-two patients with PVT constituted 19% of the study cohort of 335 recipients. While mean platelet count was found to be lower (P = .011) in the PVT group, patient age (P = .035), operation duration (P = .001), and amount of intraoperative blood transfusion (P = .010) were found to be higher. Incidence of PVT was higher in female patients than males (22.7% vs 16.1%, P = .037). There was no significant difference in survival between patients with and without PVT on 30-day (P = .285), 90-day (P = .565), 1-year (P = .777), and overall survival (P = .917). Early thrombosis did not show a better survival rate than Grades 2, 3, or 4 PVT. Thrombosis limited to portal vein was not found to bring a survival advantage compared with Grade 3 and 4 thromboses. Eversion thrombectomy was the most common procedure (66%) to overcome PVT intraoperatively.
Conclusion: Although technically more challenging, PVT is not a contraindication of LDLT. Similar outcomes can be achieved in LDLT in patients with PVT after proper restoration of portal flow, which eliminates the default survival disadvantage of patients with PVT.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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