Liver anesthesiaThe Recipient With Portal Thrombosis and/or Previous Surgery
Section snippets
Portal Vein Thrombosis
Accurate epidemiological data on PVT are difficult to obtain. Autopsy studies have reported a 0.05% to 0.5% prevalence of these conditions in the general population, while the prevalence varies from 0.6% to 64.1% among liver cirrhotic patients, depending on the diagnostic method or criteria for patient selection.1
PVT is a common condition of high clinical importance with an incidence varying from 2.1% to 26% in large review study.2 Along with different ages, the etiology of PVT is quite
Recipients With Previous Surgery
Surgical operations in the upper abdomen may not only result in a distorted anatomy, but also lead to the formation of intra-abdominal adhesions and scar formation, making the OLT procedure technically more complex, especially in the presence of portal hypertension. A late transplantation, namely, a redo procedure 6 months after the first transplantation, can show the liver to be attached to the surrounding organs and structures due to adhesions and fibrous reaction. In all these cases,
Epidemiology
Between July 30, 1999, and November 14, 2007, we performed 289 deceased orthotopic liver transplantation and 77 living donor liver transplantation (LDLT) in 338 adult patients. The end of follow-up was November 14, 2007. During the study period, portal thrombosis was discovered by imaging studies and confirmed at the time of the surgery in 33 patients (9.01%, Group A).
In the same period, 34 recipients had undergone previous surgery (Group B). The control group consisted of 33 patients without
Results
Group A showed a mean age of 53.63 years (range 35 to 66 years) with a gender distribution of 20 men (60.6%) and 13 women (39.3%). Group B had a mean age of 56.91 years (range, 35 to 68 years), with a gender distribution of 24 men (70.5%) and 10 women (29.57%). Group C showed a mean age of 52.63 years (range, 19 to 65 years) with a gender distribution of 24 men (72.7%) and 9 women (27.3%; Table 1).
The indications for transplantation are shown in Table 2. To compare the groups of patients, we
Discussion
In our series the incidence of marginal recipients due to PVT was 9.01%, and due to previous surgery 9.28%. In regard to the surgical intervention itself, although the durations of the anhepatic phase and the transplant itself were slightly longer, the differences were not statistically significant compared with other patients transplanted in our hospital, in contrast to the data available in the literature.10
The transfusion requirements were also not different between the two groups except for
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Cited by (19)
The Impact of Previous Abdominal Surgery in a High-Acuity Liver Transplant Population
2021, Journal of Surgical ResearchCitation Excerpt :Multivariate analysis of prognostic factors for patient survival identified recipient pre-LT ICU admission as the only negative predictive factor among PAS, UAS, high-impact UAS, and PAS ≤90 (Table S8). PAS is considered a risk factor for substandard liver transplant results.6,9,11,12 Accordingly, it is integrated into the SRTR risk adjustment model as a variable associated with inferior post-LT outcomes.13
Portal vein surgical treatment on non-tumoral portal vein thrombosis in liver transplantation: Systematic review and meta-analysis
2021, ClinicsCitation Excerpt :Data from three studies (13,24,26) evaluated 111 patients with PVT and 559 without PVT. The mean difference was 0.24 packs [0.03-0.46], p=0.03 (Figure 2D). Data from five studies (10,13,21,26,29) evaluated 269 patients with PVT and 2937 without PVT. The mean difference was 0.07 days [-0.06-0.19], (p=0.30) (Figure 3A). Data from five studies (10,13,21,26,29) evaluated 246 patients with PVT and 2,555 without PVT. The mean difference was 0.07 days [-0.06-0.20], (p=0.34) (Figure 3B).
Liver transplantation in adults with portal vein thrombosis: Data from the China Liver Transplant Registry
2016, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :According to the severity and range of PVT, removing thrombus, portal vein intima denudation, vascular bypass, and inferior vena caval portal hemitransposition can be chosen for reconstruction of the portal vein during LT [13–18]. Although the majority of articles have reported that there is a similar prognosis between patients with and without PVT [7,19], a number of articles also indicate that there is a significantly increased incidence of postoperative complications in patients with PVT, particularly in patients with diffuse PVT [4,10,12]. At present, LT for patients with diffuse PVT remains a formidable technical challenge [20].
Portal vein thrombosis in cirrhosis
2014, Journal of Clinical and Experimental HepatologyPortal vein thrombosis and liver transplantation: Implications for waiting list period, surgical approach, early and late follow-up
2014, Transplantation ReviewsCitation Excerpt :PVT recurrence is not an uncommon event in the large part of series, ranging from 36% [10] of pioneering experiences to 2–3% of some recent ones [18,26,36]. Re-thrombosis occurs especially in the early post-operative period (Table 2) [1,2,7,10,11,14–18,21–24,26,28–32,37,38,42]. The reported in-hospital post-LT mortality is heterogeneous; one study reports a worse outcome for patients with PVT respect to those without [42] and in another series [33] patients with complete PVT had a higher in-hospital mortality than those with partial PVT. Nevertheless, two recent large studies [27,29] did not find significant differences between patients with or without PVT.