Objectives: Portal vein (PV) reconstruction is a crucial factor for successful living donor liver transplantation (LDLT). Portal vein thrombosis (PVT) remains a critical problem in LDLT because of technical demands and sufficient venous graft harvesting. This study aimed to describe in detail of PV reconstruction and outcomes of patients with PVT.

Methods: We performed adult-to-adult LDLT for 123 patients between March 2002 and December 2016. Thirteen patients (10.6%) had PVT at the time of LDLT, which were classified as grade I in 2 patients, grade II in 4 patients, grade III in 6 patients and grade IV in 1 patient, according to Yerdel's classification. We retrospectively analyzed the surgical technique and postoperative complications of PV reconstruction for patients with PVT, and compared to patients without PVT.

Results: Surgical treatments for 13 patients with PVT were as follows: thrombectomy alone in 2 patients, replaced interpositional venous grafts in 8 patients: 3 using internal jugular vein (IJV) and 5 using external iliac vein (EIV), mesoportal jump grafts in 2 patients: 1 using IJV and 1 using IJV+EIV, and renoportal anastomosis using external iliac venous graft in 1 patient. Among 8 patients with interpositional venous grafts, 5 venous grafts (IJV: 2, EIV: 3) were passed dorsal side of the pancreas without using jump graft. The postoperative complication associated with PV anastomosis of patients with PVT occurred in 1 of 13 (7.7%) patients, who developed anastomosis bleeding caused by coagulation disorders at POD27. On the other hand, 1 of 110 (0.9%) patients without PVT also developed same postoperative PV complication at POD2. Post-transplant survival rates at 1 and 5 years were not statistically differences between patients with and without PVT (1 year; 84.6% vs. 79.1%, 5 years; 53.8% vs. 65.8%, p=0.332).

Conclusion: The outcomes of PV reconstruction in the patients with PVT by suitable surgical techniques using venous grafts are satisfactory, being comparable to those of patients without PVT in adult-to-adult LDLT.

CITATION INFORMATION: Kuriyama N., Hayasaki A., Fujii T., Iizawa Y., Kato H., Murata Y., Tanemura A., Azumi Y., Kishiwada M., Mizuno S., Usui M., Sakurai H., Isaji S. Surgical Technique and Outcomes of Portal Vein Reconstruction of Adult-to-Adult Living Donor Liver Transplantation Recipients with Portal Vein Thrombosis Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress