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Kim SH, Moon DB, Kang WH, Jung DH, Lee SG. A surgical technique using the gastroepiploic vein for portal inflow restoration in living donor liver transplantation in a patient with diffuse portomesenteric thrombosis. Hepatobiliary Pancreat Dis Int 2023; 22:537-540. [PMID: 37005146 DOI: 10.1016/j.hbpd.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Sang-Hoon Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Deok-Bog Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
| | - Woo-Hyoung Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
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Barrera-Lozano LM, Ramírez-Arbeláez JA, Muñoz CL, Becerra JA, Toro LG, Ardila CM. Portal Vein Thrombosis in Liver Transplantation: A Retrospective Cohort Study. J Clin Med 2023; 12:3951. [PMID: 37373645 PMCID: PMC10299236 DOI: 10.3390/jcm12123951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Portal vein thrombosis was considered a contraindication for liver transplantation. This study analyzes the perioperative complications and survival of liver transplant patients with portal vein thrombosis (PVT). A retrospective observational cohort study of liver transplant patients was conducted. The outcomes were early mortality (30 days) and patient survival. A total of 201 liver transplant patients were identified and 34 (17%) patients with PVT were found. The most frequent extension of thrombosis was Yerdel 1 (58.8%), and a portosystemic shunt was identified in 23 (68%) patients. Eleven patients (33%) presented any early vascular complication, PVT being the most frequent (12%). The multivariate regression analysis showed a statistically significant association between PVT and early complications (OR = 3.3, 95% confidence interval 1.4-7.7; p = 0.006). Moreover, early mortality was observed in eight patients (24%), of which two (5.9%) presented Yerdel 2. For Yerdel 1, patient survival according to the extent of thrombosis was 75% at 1 year and 3 years, while for Yerdel 2, it was 65% at 1 year, and 50% at 3 years (p = 0.04). Portal vein thrombosis significantly influenced early vascular complications. Furthermore, portal vein thrombosis Yerdel 2 or higher impacts the survival of liver grafts in the short and long term.
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Affiliation(s)
- Luis Manuel Barrera-Lozano
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia; (L.M.B.-L.); (J.A.R.-A.); (C.L.M.); (L.G.T.)
- Vascular Medicine Department, Faculty of Medicine, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - Jaime Alberto Ramírez-Arbeláez
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia; (L.M.B.-L.); (J.A.R.-A.); (C.L.M.); (L.G.T.)
| | - Cristian Leonardo Muñoz
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia; (L.M.B.-L.); (J.A.R.-A.); (C.L.M.); (L.G.T.)
| | | | - Luis Guillermo Toro
- Transplant Department, Hospital San Vicente Fundación, Rionegro 054047, Colombia; (L.M.B.-L.); (J.A.R.-A.); (C.L.M.); (L.G.T.)
| | - Carlos M. Ardila
- Basic Studies Department, School of Dentistry, Universidad de Antioquia UdeA, Medellín 050010, Colombia
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3
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Fundora Y, Hessheimer AJ, Del Prete L, Maroni L, Lanari J, Barrios O, Clarysse M, Gastaca M, Barrera Gómez M, Bonadona A, Janek J, Boscà A, Álamo Martínez JM, Zozaya G, López Garnica D, Magistri P, León F, Magini G, Patrono D, Ničovský J, Hakeem AR, Nadalin S, McCormack L, Palacios P, Zieniewicz K, Blanco G, Nuño J, Pérez Saborido B, Echeverri J, Bynon JS, Martins PN, López López V, Dayangac M, Lodge JPA, Romagnoli R, Toso C, Santoyo J, Di Benedetto F, Gómez-Gavara C, Rotellar F, Gómez-Bravo MÁ, López Andújar R, Girard E, Valdivieso A, Pirenne J, Lladó L, Germani G, Cescon M, Hashimoto K, Quintini C, Cillo U, Polak WG, Fondevila C. Alternative forms of portal vein revascularization in liver transplant recipients with complex portal vein thrombosis. J Hepatol 2023; 78:794-804. [PMID: 36690281 DOI: 10.1016/j.jhep.2023.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Complex portal vein thrombosis (PVT) is a challenge in liver transplantation (LT). Extra-anatomical approaches to portal revascularization, including renoportal (RPA), left gastric vein (LGA), pericholedochal vein (PCA), and cavoportal (CPA) anastomoses, have been described in case reports and series. The RP4LT Collaborative was created to record cases of alternative portal revascularization performed for complex PVT. METHODS An international, observational web registry was launched in 2020. Cases of complex PVT undergoing first LT performed with RPA, LGA, PCA, or CPA were recorded and updated through 12/2021. RESULTS A total of 140 cases were available for analysis: 74 RPA, 18 LGA, 20 PCA, and 28 CPA. Transplants were primarily performed with whole livers (98%) in recipients with median (IQR) age 58 (49-63) years, model for end-stage liver disease score 17 (14-24), and cold ischemia 431 (360-505) minutes. Post-operatively, 49% of recipients developed acute kidney injury, 16% diuretic-responsive ascites, 9% refractory ascites (29% with CPA, p <0.001), and 10% variceal hemorrhage (25% with CPA, p = 0.002). After a median follow-up of 22 (4-67) months, patient and graft 1-/3-/5-year survival rates were 71/67/61% and 69/63/57%, respectively. On multivariate Cox proportional hazards analysis, the only factor significantly and independently associated with all-cause graft loss was non-physiological portal vein reconstruction in which all graft portal inflow arose from recipient systemic circulation (hazard ratio 6.639, 95% CI 2.159-20.422, p = 0.001). CONCLUSIONS Alternative forms of portal vein anastomosis achieving physiological portal inflow (i.e., at least some recipient splanchnic blood flow reaching transplant graft) offer acceptable post-transplant results in LT candidates with complex PVT. On the contrary, non-physiological portal vein anastomoses fail to resolve portal hypertension and should not be performed. IMPACT AND IMPLICATIONS Complex portal vein thrombosis (PVT) is a challenge in liver transplantation. Results of this international, multicenter analysis may be used to guide clinical decisions in transplant candidates with complex PVT. Extra-anatomical portal vein anastomoses that allow for at least some recipient splanchnic blood flow to the transplant allograft offer acceptable results. On the other hand, anastomoses that deliver only systemic blood flow to the allograft fail to resolve portal hypertension and should not be performed.
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Affiliation(s)
- Yiliam Fundora
- General & Digestive Surgery Service, Hospital Clínic, Barcelona, Spain
| | - Amelia J Hessheimer
- General & Digestive Surgery Service, Hospital Clínic, Barcelona, Spain; General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Luca Del Prete
- Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Maroni
- Hepatobiliary Surgery & Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, Italy
| | - Jacopo Lanari
- Department of Surgery, Oncology, & Gastroenterology, Hepatobiliary & Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Oriana Barrios
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Mikel Gastaca
- Hepatobiliary Surgery & Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bilbao, Spain
| | - Manuel Barrera Gómez
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Agnès Bonadona
- Grenoble Alpes University, CHU Grenoble Alpes, Digestive Surgery & Liver Transplantation, Grenoble, France
| | - Julius Janek
- Department of Transplant Surgery, F.D. Roosevelt Hospital, Banská Bystrica, Slovakia
| | - Andrea Boscà
- Liver Transplantation & Hepatology Laboratory, Hepatology, HPB Surgery & Transplant Unit, Health Research Institute Hospital La Fe, La Fe University Hospital, Valencia, Spain
| | | | - Gabriel Zozaya
- HPB and Liver Transplant Unit, Clínica Universidad de Navarra; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | | | - Paolo Magistri
- Hepato-pancreato-biliary Surgery & Liver Transplantation Unit, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Francisco León
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Giulia Magini
- Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Damiano Patrono
- General Surgery 2U - Liver Transplant Centre, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Jiří Ničovský
- Centrum Kardiovaskulární a Transplantační Chirurgie, Brno, Czechia
| | - Abdul Rahman Hakeem
- Department of HPB and Liver Transplant Surgery, St. James's University Hospital, Leeds, UK
| | - Silvio Nadalin
- University of Tübingen, Tübingen, Germany; European Liver and Intestine Transplant Association (ELITA) Board
| | | | - Pilar Palacios
- Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - Krzysztof Zieniewicz
- Medical University of Warsaw, Warsaw, Poland; European Liver and Intestine Transplant Association (ELITA) Board
| | - Gerardo Blanco
- Hospital Universitario de Badajoz, Universidad de Extremadura, Badajoz, Spain
| | - Javier Nuño
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Baltasar Pérez Saborido
- Hepatobiliopancreatic Surgery & Liver Transplant Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Juan Echeverri
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J Steve Bynon
- University of Texas Houston - Memorial Hermann TMC, Houston, Texas, USA
| | - Paulo N Martins
- University of Massachusetts - Memorial Medical Center, Worcester, Massachusetts, USA
| | - Víctor López López
- Department of Surgery & Transplantation, Hospital Clínico Universitario Virgen de la Arrixaca, Murcian Institue of Biosanitary Research (IMIB), Murcia, Spain
| | - Murat Dayangac
- Medipol University Hospital Center for Organ Transplantation, Istanbul, Turkey
| | - J Peter A Lodge
- Department of HPB and Liver Transplant Surgery, St. James's University Hospital, Leeds, UK
| | - Renato Romagnoli
- General Surgery 2U - Liver Transplant Centre, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Christian Toso
- Hôpitaux Universitaires de Genève, Geneva, Switzerland; European Liver and Intestine Transplant Association (ELITA) Board
| | - Julio Santoyo
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fabrizio Di Benedetto
- Hepato-pancreato-biliary Surgery & Liver Transplantation Unit, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | - Fernando Rotellar
- HPB and Liver Transplant Unit, Clínica Universidad de Navarra; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | | | - Rafael López Andújar
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation & Hepatology Laboratory, Hepatology, HPB Surgery & Transplant Unit, Health Research Institute Hospital La Fe, La Fe University Hospital, Valencia, Spain
| | - Edouard Girard
- Grenoble Alpes University, CHU Grenoble Alpes, Digestive Surgery & Liver Transplantation, Grenoble, France
| | - Andrés Valdivieso
- Hepatobiliary Surgery & Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bilbao, Spain
| | - Jacques Pirenne
- Abdominal Transplant Surgery, UZ Leuven, KUL, Leuven, Belgium
| | - Laura Lladó
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Giacomo Germani
- Department of Surgery, Oncology, & Gastroenterology, Hepatobiliary & Liver Transplantation Unit, Padua University Hospital, Padua, Italy; European Liver and Intestine Transplant Association (ELITA) Board
| | - Matteo Cescon
- Hepatobiliary Surgery & Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, Italy
| | - Koji Hashimoto
- Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Cristiano Quintini
- Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Umberto Cillo
- Department of Surgery, Oncology, & Gastroenterology, Hepatobiliary & Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Wojciech G Polak
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Liver and Intestine Transplant Association (ELITA) Board
| | - Constantino Fondevila
- General & Digestive Surgery Service, Hospital Clínic, Barcelona, Spain; General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; European Liver and Intestine Transplant Association (ELITA) Board.
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Riffert DA, Matsuoka L, Brown DB, Alexopoulos SP. Recurrent Portal Vein Thrombosis In Liver Transplantation With Renoportal Anastomosis Caused by Spontaneous Reno-Caval Shunts: A Case Report. Transplant Proc 2023; 55:680-683. [PMID: 36966084 DOI: 10.1016/j.transproceed.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/19/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) in patients with cirrhosis complicated by portal hypertension, portosystemic shunts, and chronic portal vein thrombosis (PVT) has long been challenging. Spontaneous spleno-renal shunts (SRS) allow new surgical techniques to restore portal vein patency and hepatopetal flow. Renoportal anastomosis (RPA) has emerged as an accepted method for transplanting these patients, with good long-term patient and graft survival. Orthotopic liver transplantation with RPA is known to be complicated by recurrent PVT, with few details discussed in the literature. CASE REPORT We present a case of a 56-year-old woman with decompensated cirrhosis who underwent deceased donor whole graft OLT using RPA with iliac vein conduit. The postoperative course was complicated by occlusive thrombosis in the portal vein and iliac vein conduit. Venography revealed enlarged left gonadal and lumbar vein varices acting as reno-caval shunts with hepatofugal flow. Embolization of the varices re-established durable venous patency that was confirmed on post-transplant day 68 with no other hemodynamic complications. DISCUSSION This showcases an interesting mechanism by which recurrent PVT may occur in patients undergoing OLT with RPA. Because durable portal vein patency can be achieved with Interventional Radiology embolization of reno-caval varices, assessing these communications is an important preoperative consideration for planned OLT with RPA.
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Affiliation(s)
- Derek A Riffert
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lea Matsuoka
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Daniel B Brown
- Division of Interventional Radiology, Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sophoclis P Alexopoulos
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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5
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Misra AC, Emamaullee J. CAQ Corner: Surgical evaluation for liver transplantation. Liver Transpl 2022; 28:1936-1943. [PMID: 35575000 PMCID: PMC9666671 DOI: 10.1002/lt.26505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/12/2022] [Accepted: 05/11/2022] [Indexed: 01/07/2023]
Abstract
The evaluation of a liver transplantation candidate is a complex and detailed process that in many cases must be done in an expedited manner because of the critically ill status of some patients with end-stage liver disease. It involves great effort from and the collaboration of multiple disciplines, and during the evaluation several studies and interventions are performed to assess and potentially prepare a patient for liver transplant. Here we review the liver transplantation evaluation from a surgical perspective.
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Affiliation(s)
- Asish C. Misra
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Department of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA,Division of Hepatobiliary and Abdominal Organ Transplantation SurgeryChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Juliet Emamaullee
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Department of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA,Division of Hepatobiliary and Abdominal Organ Transplantation SurgeryChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
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6
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Perfecto A, Gastaca M, Prieto M, Palomares I, Ventoso A, Ruiz P, Mambrilla S, Muga E, Senosiain M, Salvador P, Testillano M, Fernández JR, Bustamante FJ, Valdivieso A. Renoportal Anastomosis and Its Complications: A Complex Case Report. Transplant Proc 2022; 54:2552-2555. [DOI: 10.1016/j.transproceed.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/22/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
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7
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Talwar A, Varghese J, Knight GM, Katariya N, Caicedo JC, Dietch Z, Borja-Cacho D, Ladner D, Christopher D, Baker T, Abecassis M, Mouli S, Desai K, Riaz A, Thornburg B, Salem R. Preoperative portal vein recanalization-transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation. Hepatol Commun 2022; 6:1803-1812. [PMID: 35220693 PMCID: PMC9234680 DOI: 10.1002/hep4.1914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 11/09/2022] Open
Abstract
High-grade portal vein thrombosis (PVT) is often considered to be a technically challenging scenario for liver transplantation (LT) and in some centers a relative contraindication. This study compares patients with chronic obliterative PVT who underwent portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) and subsequent LT to those with partial nonocclusive PVT who underwent LT without an intervention. This institutional review board-approved study analyzed 49 patients with cirrhosis with PVT from 2000 to 2020 at our institution. Patients were divided into two groups, those that received PVR-TIPS due to anticipated surgical challenges from chronic obliterative PVT and those who did not because of partial PVT. Demographic data and long-term outcomes were compared. A total of 35 patients received PVR-TIPS while 14 did not, with all receiving LT. Patients with PVR-TIPS had a higher Yerdel score and frequency of cavernoma than those that did not. PVR-TIPS was effective in decreasing portosystemic gradient (16 down to 8 mm HG; p < 0.05). Both groups allowed for end-to-end anastomoses in >90% of cases. However, veno-veno bypass was used significantly more in patients who did not receive PVR-TIPS. Additionally, patients without PVR-TIPS required significantly more intraoperative red blood cells. Overall survival was not different between groups. PVR-TIPS demonstrated efficacy in resolving PVT and allowed for end-to-end portal vein anastomoses. PVR-TIPS is a viable treatment option for chronic obliterative PVT with or without cavernoma that simplifies the surgical aspects of LT.
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Affiliation(s)
- Abhinav Talwar
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Jeffrey Varghese
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Gabriel M Knight
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Nitin Katariya
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Juan-Carlos Caicedo
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Zach Dietch
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Daniel Borja-Cacho
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Daniella Ladner
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Derrick Christopher
- Department of SurgeryDivision of Transplant SurgeryNorthwestern UniversityChicagoIllinoisUSA
| | - Talia Baker
- Department of SurgeryDivision of Transplant SurgeryUniversity of ChicagoChicagoIllinoisUSA
| | - Michael Abecassis
- Department of SurgeryDivision of Transplant SurgeryUniversity of ArizonaTucsonArizonaUSA
| | - Samdeep Mouli
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Kush Desai
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Ahsun Riaz
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Bart Thornburg
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Riad Salem
- Department of RadiologySection of Vascular and Interventional RadiologyNorthwestern UniversityChicagoIllinoisUSA
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8
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Pinelli D, Neri F, Tornese S, Amaduzzi A, Camagni S, D'Antiga L, Fagiuoli S, Colledan M. Physiological reno-portal bypass in liver transplantation with non-tumorous portal vein thrombosis. Updates Surg 2022; 74:1617-1626. [PMID: 35441945 DOI: 10.1007/s13304-022-01280-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022]
Abstract
Reno-portal anastomosis (RPA) in presence of spleno-renal shunts (SRS) is a physiological option to restore blood flow in liver transplantation with portal vein thrombosis (PVT). Diffuse splanchnic venous system thrombosis (complex PVT) is its main indication but RPA proved to be useful in selected cases of less extensive thrombosis (non-complex PVT). Up until now only two monocentric and one multicentric case series has been published on this topic in addition to few anecdotal reports. After 2014, we introduced RPA in our institution to manage some cases of complex PVT in presence of SRS. Here, we present the evolution of indication to RPA. From 2014 to 2020, we performed ten RPA: nine patients presented non-complex and one complex PVT. Overall early and late complication rates were 66.6% and 50%, respectively. Two patients developed RPA stenosis, treated by interventional radiology. Self-resolving acute kidney injury (AKI) was observed in three cases. No re-transplantation was necessary. RPA was patent in all patients, with a mean follow-up of 41.9 months. The overall patient survival was 70% at 1 year and 60% at 3 and 5 years. Four patients died at 1, 2, 3 and 20 months from LT. Causes of deaths were, respectively, stroke, cerebral infection, sepsis (MOF) and sudden variceal bleeding in sinusoidal obstruction syndrome. The relative simplicity and effectiveness of RPA in presence of SRS allowed us to rely more and more often on this technique in liver transplantation with challenging non-complex PVT.
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Affiliation(s)
- Domenico Pinelli
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy.
| | - Flavia Neri
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Stefania Tornese
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Annalisa Amaduzzi
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Stefania Camagni
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Lorenzo D'Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Michele Colledan
- General Surgery, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
- Università di Milano - Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milano, MI, Italy
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9
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Kitano Y, Pietrasz D, Fernandez-Sevilla E, Golse N, Vibert E, Sa Cunha A, Azoulay D, Cherqui D, Baba H, Adam R, Allard MA. Subjective Difficulty Scale in Liver Transplantation: A Prospective Observational Study. Transpl Int 2022; 35:10308. [PMID: 35387395 PMCID: PMC8977402 DOI: 10.3389/ti.2022.10308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
The predictive value of a subjective difficulty scale (DS) after surgical procedures is unknown. The objective of this study was to evaluate the prognostic value of a DS after liver transplantation (LT) and to identify predictors of difficulty. Surgeons prospectively evaluated the difficulty of 441 consecutive liver transplantations from donation after brain death at the end of the surgery by using a DS from 0 to 10 (“the easiest to the hardest you can imagine”). DS was associated with severe morbidity. The risk of graft loss at 1 year remained unchanged from 0 to 6 but increased beyond 6. Graft survival and patient survival of group with DS 7–10 was significantly impaired compared to groups with DS: 0–3 or DS: 4–6 but were significantly impaired for the group with DS: 7–10. Independent predictors of difficult LT (DS ≥ 7) were annular segment 1, transjugular intrahepatic portosystemic shunt, retransplantation beyond 30 days, portal vein thrombosis, and ascites. Of them, ascites was a borderline non-significant covariate (p = .04). Vascular complications occurred more often after difficult LT (20.5% vs. 5.9%), whereas there was no difference in the other types of complications. DS can be used to tailor monitoring and anticipate early complications. External validation is needed.
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Affiliation(s)
- Yuki Kitano
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daniel Pietrasz
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France
| | - Elena Fernandez-Sevilla
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France
| | - Nicolas Golse
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Antonio Sa Cunha
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris, Saclay, France
| | - Daniel Azoulay
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris, Saclay, France
| | - Marc-Antoine Allard
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris, Saclay, France
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10
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Lin GL, Xiao M, Zhuang L, Yang Y, Li QY, Lu JF, Li MX, Zheng SS. Combination of renoportal anastomosis and inferior mesenteric vein-portal anastomosis in liver transplantation: A new portal reconstruction technique. Hepatobiliary Pancreat Dis Int 2022; 21:182-185. [PMID: 34412966 DOI: 10.1016/j.hbpd.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/02/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Guo-Ling Lin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China
| | - Min Xiao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China
| | - Li Zhuang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China
| | - Yu Yang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China
| | - Qi-Yong Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China
| | - Jian-Fang Lu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Nursing, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China
| | - Meng-Xia Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Zhejiang University School of Medicine, Hangzhou, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China; Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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11
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Pinelli D, Camagni S, Amaduzzi A, Frosio F, Fontanella L, Carioli G, Guizzetti M, Zambelli MF, Giovanelli M, Fagiuoli S, Colledan M. Liver transplantation in patients with non-neoplastic portal vein thrombosis: 20 years of experience in a single center. Clin Transplant 2021; 36:e14501. [PMID: 34633110 DOI: 10.1111/ctr.14501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/14/2021] [Accepted: 09/25/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Yerdel classification is widely used for describing the severity of portal vein thrombosis (PVT) in liver transplant (LT) candidates, but might not accurately predict transplant outcome. METHODS We retrospectively analyzed data regarding 97 adult patients with PVT who underwent LT, investigating whether the complexity of portal reconstruction could better correlate with transplant outcome than the site and extent of the thrombosis. RESULTS 79/97 (80%) patients underwent thrombectomy and anatomical anastomosis (TAA), 18/97 (20%) patients underwent non-anatomical physiological reconstructions (non-TAA). PVT Yerdel grade was 1-2 in 72/97 (74%) patients, and 3-4 in 25/97 (26%) patients. Univariate analysis revealed higher 30-day mortality, 90-day mortality, 1-year mortality, and a higher rate of severe early complications in the non-TAA group than in the TAA group (p = .018, .001, .014, .009, respectively). In the model adjusted for PVT Yerdel grade, non-TAA remained independently associated with higher 30-day, 90-day, and 1-year mortality (p = .021, .007, and .015, respectively). The portal vein re-thrombosis and overall patient and graft survival rates were similar. DISCUSSION In our experience, the complexity of portal reconstruction better correlated with transplant outcome than the Yerdel classification, which did not even appear to be a reliable predictor of the surgical complexity and technique.
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Affiliation(s)
- Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefania Camagni
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Annalisa Amaduzzi
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabio Frosio
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Fontanella
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Greta Carioli
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Guizzetti
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mara Giovanelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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12
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Maruyama H, Shiina S. Collaterals in portal hypertension: anatomy and clinical relevance. Quant Imaging Med Surg 2021; 11:3867-3881. [PMID: 34341755 DOI: 10.21037/qims-20-1328] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/07/2021] [Indexed: 12/14/2022]
Abstract
Portal hypertension is a key pathophysiology of chronic liver diseases typified with cirrhosis or noncirrhotic portal hypertension. The development of collateral vessels is a characteristic feature of impaired portal hemodynamics. The paraumbilical vein (PUV), left gastric vein (LGV), posterior gastric vein (PGV), short gastric vein (SGV), splenorenal shunt (SRS), and inferior mesenteric vein (IMV) are major collaterals, and there are some rare collaterals. The degree and hemodynamics of collateral may affect the portal venous circulation and may compensate for the balance between inflow and outflow volume of the liver. Additionally, the development of collateral shows a relation with the liver function reserve and clinical manifestations such as esophageal varices (EV), gastric varices, rectal varices and the other ectopic varices, hepatic encephalopathy, and prognosis. Furthermore, there may be an interrelationship in the development between different collaterals, showing additional influences on the clinical presentations. Thus, the assessment of collaterals may enhance the understanding of the underlying pathophysiology of the condition of patients with portal hypertension. This review article concluded that each collateral has a specific function depending on the anatomy and hemodynamics and is linked with the relative clinical presentation in patients with portal hypertension. Imaging modalities may be essential for the detection, grading and evaluation of the role of collaterals and may help to understand the pathophysiology of the patient condition. Further investigation in a large-scale study would elucidate the basic and clinical significance of collaterals in patients with portal hypertension and may provide information on how to manage them to improve the prognosis as well as quality of life.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
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13
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D'Amico G, Matsushima H, Del Prete L, Diago Uso T, Armanyous SR, Hashimoto K, Eghtesad B, Fujiki M, Aucejo F, Sasaki K, Kwon CHD, Simioni A, Miller C, Quintini C. Long term outcomes and complications of reno-portal anastomosis in liver transplantation: results from a propensity score-based outcome analysis. Transpl Int 2021; 34:1938-1947. [PMID: 34008257 DOI: 10.1111/tri.13920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
Diffuse splanchnic vein thrombosis (DSVT) remains a serious challenge in liver transplantation (LT). Reno-portal anastomosis (RPA) has previously been reported as a valid option for management of patients with DSVT during LT. The aim of this study was to evaluate post-transplant renal function and surgical outcomes of patients with DSVT who underwent RPA during LT. Between January 2005 and December 2017, 1270 patients underwent LT at our institution, including 16 with DSVT managed with RPA (RPA group). We compared renal function and surgical outcomes in these patients to outcomes in 48 propensity score (PS)-matched patients without thrombosis (control group), using a 1:3 matching model. The two groups had similar rates of postoperative portal vein thrombosis (PVT), renal dysfunction as measured by estimated glomerular filtration rate (eGFR), and overall postoperative complications (Clavien grade III), although the RPA group had a higher incidence of postoperative upper gastrointestinal (GI) bleeding (31.3% vs 4.2%; P = 0.009) that had no clinical consequence. There were no significant differences in five-year graft and patient survival rates between the groups (P = 0.133 and P = 0.166, respectively). RPA is an established technique in the management of patients with DSVT during LT, with comparable outcomes to patients without thrombosis. Our report is the first to demonstrate similar surgical outcomes, including long-term renal function, in LT recipients with or without RPA.
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Affiliation(s)
| | | | - Luca Del Prete
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Koji Hashimoto
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| | - Bijan Eghtesad
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| | - Masato Fujiki
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| | - Federico Aucejo
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| | - Kazunari Sasaki
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| | | | - Andrea Simioni
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Miller
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
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14
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Liou P, Kato T, Fishbein T. Surgical Perspectives on the American Association for the Study of Liver Diseases Guideline for Anticoagulation and Implications for Liver Transplantation. Liver Transpl 2021; 27:580-583. [PMID: 37160043 DOI: 10.1002/lt.25990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Peter Liou
- Center for Liver Disease and Transplantation, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Tomoaki Kato
- Center for Liver Disease and Transplantation, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Thomas Fishbein
- Transplant Institute, MedStar Georgetown University Hospital, Washington, DC
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15
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Durand F, Dokmak S, Roux O, Francoz C. Liver Transplantation in the Setting of Non-malignant Portal Vein Thrombosis. PORTAL VEIN THROMBOSIS 2021:131-156. [DOI: 10.1007/978-981-33-6538-4_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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16
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Guarner P, García R, Al Shwely F, Pérez-Serrano C, Rodríguez S, Torroella A, Ferrer J, Fondevila C, Fuster J, García-Valdecasas JC. Unusual Allogeneic Retrohepatic Vena Cava Graft for Renoportal Anastomosis in Orthotopic Liver Transplantation. Liver Transpl 2020; 26:1056-1059. [PMID: 32078242 DOI: 10.1002/lt.25735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/14/2020] [Accepted: 01/25/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Pol Guarner
- Liver Transplantation Unit, Department of General Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Rocío García
- Liver Transplantation Unit, Department of General Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Farah Al Shwely
- Liver Transplantation Unit, Department of General Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Carlos Pérez-Serrano
- Department of Radiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Sonia Rodríguez
- Department of Radiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alba Torroella
- Liver Transplantation Unit, Department of General Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Joana Ferrer
- Liver Transplantation Unit, Department of General Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Constantino Fondevila
- Liver Transplantation Unit, Department of General Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep Fuster
- Liver Transplantation Unit, Department of General Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Juan Carlos García-Valdecasas
- Liver Transplantation Unit, Department of General Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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17
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Kisaoglu A, Dandin O, Demiryilmaz I, Dinc B, Adanir H, Yilmaz VT, Aydinli B. A Single-Center Experience in Portal Flow Augmentation in Liver Transplantation With Prior Large Spontaneous Splenorenal Shunt. Transplant Proc 2020; 53:54-64. [PMID: 32605772 DOI: 10.1016/j.transproceed.2020.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/30/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
Large portosystemic shunts may cause portal steal syndrome in liver transplantation (LT). Because of the possible devastating consequences of the syndrome, the authors recommend perioperative management of these large shunts. Fourteen adult recipients who underwent portal flow augmentation, including left renal vein ligation (LRVL), renoportal anastomosis (RPA), shunt ligation (SL), and splenic vein ligation (SVL) for large spontaneous splenorenal shunt (SSRS), are included in this study, and the results were analyzed. A total of 13 patients had a large SSRS, and in 1 patient, the large shunt was placed between the superior mesenteric vein and the right renal vein. LDLT was performed in 13 patients. LRVL (n = 5), SVL (n = 6), RPA (n = 2), SL (n = 1) were performed to the patients as graft inflow augmentation. The graft-recipient weight ratios (GRWR) were less than 0.8% in 5 patients (35.7%): 2 had LRVL, and 3 had SVL. Small-for-size syndrome (SFSS) occurred only in these 2 patients with LRVL (GRWR ≤0.8%) and, splenic artery ligation was performed for graft inflow modulation. No mortality or serious complications were reported during follow-up. We consider that in patients with large SSRS and small-for-size grafts, SVL can be performed safely and with satisfactory outcomes.
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Affiliation(s)
- Abdullah Kisaoglu
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Tuncer Karpuzoglu Organ Transplantation Center, Antalya, Turkey
| | - Ozgur Dandin
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Tuncer Karpuzoglu Organ Transplantation Center, Antalya, Turkey.
| | - Ismail Demiryilmaz
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Tuncer Karpuzoglu Organ Transplantation Center, Antalya, Turkey
| | - Bora Dinc
- Akdeniz University, Faculty of Medicine, Department of Anesthesiology, Antalya, Turkey
| | - Haydar Adanir
- Akdeniz University, Faculty of Medicine, Department of Gastroenterology, Antalya, Turkey
| | - Vural Taner Yilmaz
- Akdeniz University, Faculty of Medicine, Department of Nephrology, Tuncer Karpuzoglu Organ Transplantation Center, Antalya, Turkey
| | - Bulent Aydinli
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Tuncer Karpuzoglu Organ Transplantation Center, Antalya, Turkey
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18
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Teng F, Sun KY, Fu ZR. Tailored classification of portal vein thrombosis for liver transplantation: Focus on strategies for portal vein inflow reconstruction. World J Gastroenterol 2020; 26:2691-2701. [PMID: 32550747 PMCID: PMC7284174 DOI: 10.3748/wjg.v26.i21.2691] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
Portal vein thrombosis (PVT) is currently not considered a contraindication for liver transplantation (LT), but diffuse or complicated PVT remains a major surgical challenge. Here, we review the prevalence, natural course and current grading systems of PVT and propose a tailored classification of PVT in the setting of LT. PVT in liver transplant recipients is classified into three types, corresponding to three portal reconstruction strategies: Anatomical, physiological and non-physiological. Type I PVT can be removed via low dissection of the portal vein (PV) or thrombectomy; porto-portal anastomosis is then performed with or without an interposed vascular graft. Physiological reconstruction used for type II PVT includes vascular interposition between mesenteric veins and PV, collateral-PV and splenic vein-PV anastomosis. Non-physiological reconstruction used for type III PVT includes cavoportal hemitransposition, renoportal anastomosis, portal vein arterialization and multivisceral transplantation. All portal reconstruction techniques were reviewed. This tailored classification system stratifies PVT patients by surgical complexity, risk of postoperative complications and long-term survival. We advocate using the tailored classification for PVT grading before LT, which will urge transplant surgeons to make a better preoperative planning and pay more attention to all potential strategies for portal reconstruction. Further verification in a large-sample cohort study is needed.
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Affiliation(s)
- Fei Teng
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Ke-Yan Sun
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Zhi-Ren Fu
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
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19
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The devil is in the detail: current management of perioperative surgical complications after liver transplantation. Curr Opin Organ Transplant 2020; 24:138-147. [PMID: 30694994 DOI: 10.1097/mot.0000000000000616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Despite advances in the field, perioperative morbidity is common after liver transplantation. This review examines the current literature to provide up-to-date management of common surgical complications associated with liver transplantation. RECENT FINDINGS Research focuses on problems with anastomoses of the vena cava, portal vein, hepatic artery, and bile ducts. Interventional endoscopic and radiological techniques are used more frequently to avoid reoperation. SUMMARY Advances in the management of perioperative surgical complications have focused on minimally invasive measures that successfully treat technical problems with implantation of liver allografts from both living and deceased donors.
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20
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Sasaki K, McVey JC, Firl DJ, Andreatos N, Moro A, Coromina Hernandez L, Matsushima H, Teresa DU, Fujiki M, Aucejo FN, Quintini C, Kwon CD, Eghtesad B, Miller CM, Hashimoto K. Sufficient hepatic artery flow compensates for poor portal vein flow after liver transplantation in patients with portal vein thrombosis. Clin Transplant 2019; 33:e13723. [PMID: 31583762 DOI: 10.1111/ctr.13723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/28/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Kazunari Sasaki
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - John C. McVey
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Daniel J. Firl
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | | | - Amika Moro
- Japanese National Physician Graduate Medical Education Program United States Naval Hospital Okinawa Okinawa Japan
| | - Laia Coromina Hernandez
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Hajime Matsushima
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Diago Uso Teresa
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Masato Fujiki
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Federico N. Aucejo
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Cristiano Quintini
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Choon‐Hyuck D. Kwon
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Bijan Eghtesad
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Charles M. Miller
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
| | - Koji Hashimoto
- Cleveland Clinic Lerner College of Medicine and Department of General Surgery Digestive Disease Institute Cleveland Clinic Cleveland Ohio
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