Background: Chronic, occlusive portal vein thrombosis (PVT) associated with cirrhosis represents a relative contraindication to liver transplantation (LT) in some centers. From a surgical perspective, portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) may facilitate LT and enhance transplant eligibility. Our objective was to evaluate the effect of PVR-TIPS on liver function, transplant eligibility and long-term outcomes following liver transplantation (LT).

Methods: 44 patients with chronic main PVT were identified during our institutional LT selection committee and, following joint imaging review by transplant surgery/radiology, were referred to interventional radiology for PVR-TIPS to enhance transplant eligibility. Following PVR-TIPS, patients were followed by hepatology/transplant until LT, and in post-transplant clinic. Baseline characteristics were recorded, TIPS venography and serial ultrasound/MRI were used subsequently to document PV patency.

Results: The main portal vein (MPV) was completely thrombosed in 17/44 (39%) patients; near complete (>95%) occlusion was noted in 27/44 (61%). Direct transhepatic and trans-splenic punctures were required in 11/43 (26%) and 3/43 cases (7%), respectively. Technical success was 43/44 (98%). At PVR-TIPS completion, persistence of MPV thrombus was noted in 33/43 (77%). One-month TIPS venography demonstrated complete resolution of MPV thrombosis in 22/29 (76%) without anticoagulation. 36 patients were listed for transplantation; 18 (50%) have been transplanted. 89% MPV patency rate and 82% survival was achieved at 5 years.

Conclusion: PVR-TIPS may be considered for patients with PVT being considered for LT. The high rate of MPV patency post-TIPS placement suggests flow re-establishment as the dominant mechanism of thrombus resolution.

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