Adult Living Donor Liver Transplantation for Patients With Portal Vein Thrombosis: A Single-center Experience

Kohei Miura, MD, PhD; Yasuhiko Sugawara, MD, PhD; Koushi Uchida, MD; Seiichi Kawabata, MD; Daiki Yoshii, MD; Kaori Isono, MD, PhD; Shintaro Hayashida, MD; Yuki Ohya, MD, PhD; Hidekazu Yamamoto, MD, PhD; Takashi Kobayashi, MD, PhD; Toshifumi Wakai, MD, PhD; Yukihiro Inomata, MD, PhD; Taizo Hibi, MD, PhD

doi:10.1097/TXD.0000000000000780

Transplantation Direct (May 2018)

Adult Living Donor Liver Transplantation for Patients With Portal Vein Thrombosis: A Single-center Experience

Kohei Miura, MD, PhD,
Yasuhiko Sugawara, MD, PhD,
Koushi Uchida, MD,
Seiichi Kawabata, MD,
Daiki Yoshii, MD,
Kaori Isono, MD, PhD,
Shintaro Hayashida, MD,
Yuki Ohya, MD, PhD,
Hidekazu Yamamoto, MD, PhD,
Takashi Kobayashi, MD, PhD,
Toshifumi Wakai, MD, PhD,
Yukihiro Inomata, MD, PhD,
Taizo Hibi, MD, PhD

Affiliations

Kohei Miura, MD, PhD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Yasuhiko Sugawara, MD, PhD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Koushi Uchida, MD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Seiichi Kawabata, MD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Daiki Yoshii, MD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Kaori Isono, MD, PhD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Shintaro Hayashida, MD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Yuki Ohya, MD, PhD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Hidekazu Yamamoto, MD, PhD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Takashi Kobayashi, MD, PhD: 2 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Toshifumi Wakai, MD, PhD: 2 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Yukihiro Inomata, MD, PhD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Taizo Hibi, MD, PhD: 1 Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.

DOI: https://doi.org/10.1097/TXD.0000000000000780
Journal volume & issue: Vol. 4, no. 5
p. e341

Abstract

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Background. Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) is associated with several technical challenges for its complicated procedures and poor outcomes. Some institutions still consider preexisting PVT as a relatively contraindication for LDLT. Methods. Between April 2010 and May 2016, 129 adults underwent LDLT at our institution, and 28 (21.7%) of whom had preexisting PVT. Portal vein thrombosis was diagnosed using preoperative imaging techniques and intraoperative findings. The characteristics and outcomes of the cases were retrospectively evaluated. Results. The type of PVT included Yerdel grade 1 in 21 (75.0%) cases, grade 2 in 3 (10.7%) cases, and grade 3 in 4 (14.3%) cases. There were no cases of Yerdel grade 4 PVT. After removing thrombus inside the vessel, we performed simple portal vein anastomosis in 25 (89.3%) cases, patch technique with vascular graft in 1 case (3.6%), and an interposition technique with vascular graft in 2 cases (7.1%). Compared with the non-PVT group, cold ischemic time was longer (P = 0.012) and the rate of postoperative PVT was higher (P = 0.001) in PVT group. In the comparison between the recipient without and with postoperative PVT, the existence of preoperative PVT was the independent risk factor in the multivariate analysis (hazard ratio, 7.511; 95% confidence interval 1.382-40.820; P = 0.020). Conclusions. Although it had a technically complicated operation, LDLT could be safely performed in the patients with PVT in our institution.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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