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Surgical strategies to treat portal vein thrombosis during adult liver transplantation

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Abstract

Background

The incidence of portal vein thrombosis (PVT) at the time of liver transplantation (LT) may be variable and underestimated. Therefore, preoperative diagnosis and stratification of its extension is so relevant for adequate surgical planning. Revascularization of the portal vein graft becomes essential for graft and patient survival after LT. Early stages of PVT may be managed with eversion thrombectomy and end-to-end anastomoses. However, severe PVT (grades 3 and 4) poses significant challenges for patients requiring LT, resulting in more complex surgeries and higher complication rates. To address these complexities, various surgical techniques have been developed, including collateral alternative vessel utilization, renoportal anastomoses, mesoportal jump graft placement, cavoportal hemitranspositions, portal vein arterialization, or even multivisceral transplantation.

Purpose

We herein describe the preoperative surgical planning as well as the different surgical strategies possible to treat portal vein thrombosis during LT.

Conclusion

A comprehensive preoperative evaluation of PVT is crucial for accurately assessing its extent and severity. This information is vital for proper surgical planning, which ultimately prepares both the surgeon and the patient for potentially complex procedures during LT. The surgical alternatives presented in this technical report offer promising solutions for treating PVT during LT, making it a viable option for selected patients.

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Funding

The funding involved in this work has been provided by our institution.

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Authors and Affiliations

  1. Department of General Surgery, Hepato-Pancreato-Biliary and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Juan D. Perón 4190. C1181ACH, Buenos Aires, Argentina

    Martin de Santibanes, Victoria Ardiles, Jimmy Walker Uño, Juan Mattera, Eduardo de Santibanes & Juan Pekolj

Authors
  1. Martin de Santibanes
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  2. Victoria Ardiles
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  3. Jimmy Walker Uño
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  4. Juan Mattera
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  5. Eduardo de Santibanes
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  6. Juan Pekolj
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Contributions

The concept of the study was derived from M.D.S. This study was designed by M.D.S., V.A., J.M.U., J.M., E.D.S., J.P. The article was written by M.D.S. M.D.S. and J.W.U. prepared all figures. M.D.S., V.A., J.M.U., J.M., E.D.S., J.P. critically revised the manuscript. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Martin de Santibanes.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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de Santibanes, M., Ardiles, V., Uño, J.W. et al. Surgical strategies to treat portal vein thrombosis during adult liver transplantation. Langenbecks Arch Surg 408, 399 (2023). https://doi.org/10.1007/s00423-023-03141-7

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