TY - JOUR
T1 - Reconstruction of the portal vein with expanded polytetrafluoroethylene jump graft in living donor liver transplantation recipients with complete portal vein thrombosis
T2 - A feasible and safe alternative
AU - Thorat, Ashok
AU - Jeng, Long Bin
AU - Hsu, Shih Chao
AU - Li, Ping Chun
AU - Yeh, Chun Chieh
AU - Chen, Te Hung
AU - Yang, Horng Ren
AU - Poon, Kin Shing
N1 - Publisher Copyright:
Copyright © Celsius Publishing House.
PY - 2018
Y1 - 2018
N2 - Portal vein thrombosis (PVT) increases the surgical complexity of living donor liver transplantation (LDLT) and pre-transplant complete PVT is associated with decreased 1-year patient survival. Increased experience in the field of liver transplantation (LT) and refinements of the surgical techniques have led to successful outcomes even in recipients with complete PVT. Such techniques include thrombectomy of the native portal vein, extensive thromboendovenectomy up to the splenomesenteric confluence, venous conduit interposition and portocaval hemi-transposition. In this report, we describe the outcome after LDLT using an expanded polytetrafluoroethylene (ePTFE) conduit from superior mesenteric vein (SMV) for portal inflow in patients with complete PVT. Materials and Methods: From 10th September 2002 to 31st May 2017, 900 LT surgeries were performed at China Medical University Hospital, Taiwan. The database of the 30 recipients (3.3%) that had pre-LT PVT was retrospectively analysed. Portal vein thrombectomy was done in 27 patients, whereas a ePTFE graft was used as a jump graft from the SMV to establish portal flow in three LDLT recipients (n=3). Results: ePTFE jump graft was used to establish portal inflow in three LDLT recipients (M:F, 3:0; mean age, 53 years). The first patient in this series did not receive any anticoagulation. At 14th month post-LDLT the ePTFE conduit was found to be thrombosed with multiple collaterals. However, the liver function tests were normal. The patient developed one episode of sepsis from which he completely recovered, and continues to have normal liver function till the latest follow up. The remaining 2 patients in this series received warfarin as anticoagulation therapy, with a dose of 3.5 mg per day. The latest imaging studies in both the recipients revealed a patent ePTFE conduit with satisfactory portal flow and normal postoperative liver function. Conclusions: The portal inflow can be successfully established in LDLT for recipients with pre-LT complete PVT without increasing the mortality risk. However, anticoagulation with warfarin must be instituted to avoid thrombotic occlusion of the ePTFE graft.
AB - Portal vein thrombosis (PVT) increases the surgical complexity of living donor liver transplantation (LDLT) and pre-transplant complete PVT is associated with decreased 1-year patient survival. Increased experience in the field of liver transplantation (LT) and refinements of the surgical techniques have led to successful outcomes even in recipients with complete PVT. Such techniques include thrombectomy of the native portal vein, extensive thromboendovenectomy up to the splenomesenteric confluence, venous conduit interposition and portocaval hemi-transposition. In this report, we describe the outcome after LDLT using an expanded polytetrafluoroethylene (ePTFE) conduit from superior mesenteric vein (SMV) for portal inflow in patients with complete PVT. Materials and Methods: From 10th September 2002 to 31st May 2017, 900 LT surgeries were performed at China Medical University Hospital, Taiwan. The database of the 30 recipients (3.3%) that had pre-LT PVT was retrospectively analysed. Portal vein thrombectomy was done in 27 patients, whereas a ePTFE graft was used as a jump graft from the SMV to establish portal flow in three LDLT recipients (n=3). Results: ePTFE jump graft was used to establish portal inflow in three LDLT recipients (M:F, 3:0; mean age, 53 years). The first patient in this series did not receive any anticoagulation. At 14th month post-LDLT the ePTFE conduit was found to be thrombosed with multiple collaterals. However, the liver function tests were normal. The patient developed one episode of sepsis from which he completely recovered, and continues to have normal liver function till the latest follow up. The remaining 2 patients in this series received warfarin as anticoagulation therapy, with a dose of 3.5 mg per day. The latest imaging studies in both the recipients revealed a patent ePTFE conduit with satisfactory portal flow and normal postoperative liver function. Conclusions: The portal inflow can be successfully established in LDLT for recipients with pre-LT complete PVT without increasing the mortality risk. However, anticoagulation with warfarin must be instituted to avoid thrombotic occlusion of the ePTFE graft.
KW - EPTFE graft
KW - Living donor liver transplantation
KW - Portal vein reconstruction
KW - Portal vein thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85044071609&partnerID=8YFLogxK
U2 - 10.21614/sgo-23-1-16
DO - 10.21614/sgo-23-1-16
M3 - 文章
AN - SCOPUS:85044071609
VL - 23
SP - 16
EP - 20
JO - Surgery, Gastroenterology and Oncology
JF - Surgery, Gastroenterology and Oncology
IS - 1
ER -