Liver Transplantation in Patients With Complete Portal Vein Thrombosis: Renoportal or Varicoportal Anastomosis Using Cryopreserved Vein Grafts

• Published in: Transplantation proceedings Vol. 49; no. 8; pp. 1820 - 1823
• Main Authors: Aktas, H., Ozer, A., Guner, O.S., Gurluler, E., Emiroglu, R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2017
• Subjects: Adult; Anastomosis, Surgical - methods; Cryopreservation; Humans; Iliac Vein - transplantation; Liver Diseases - complications; Liver Diseases - surgery; Liver Transplantation - methods; Living Donors; Male; Middle Aged; Portal Vein - surgery; Renal Veins - surgery; Survival Rate; Vascular Grafting - methods; Venous Thrombosis - complications; Venous Thrombosis - surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2017.06.029

Despite technical developments in transplantation surgery, complete portal vein thrombosis still remains a challenge for restoration of adequate portal vein inflow. Renoportal or varicoportal anastomosis provides an effective alternative solution for patients with complete portal vein thrombosis. This study describes our experience with renoportal and varicoportal anastomosis during liver transplantation. Between January 2014 and May 2016, 5 patients with complete portal vein thrombosis underwent extra-anatomic portal anastomosis. In 3 cases, varicoportal anastomosis was performed and for the others, end-to-end renoportal anastomosis. We used iliac cryopreserved vein grafts to restore portal anastomosis in 3 cases. Epidemiology, risk factors, surgical techniques, complications, and outcomes of these procedures were evaluated over short- and long-term follow-ups. The follow-up time is 3 years for our first renoportal case, which was performed in a cadaveric liver transplantation; it was also first nationwide case. The other renoportal anastomosis was practiced in a living donor liver transplantation and the follow-up time is 8 months. The patient and graft survival rates were 100% at the last follow-up. The follow-up times are 10.9 and 4 months for the patients with varicoportal anastomosis. One of these patients died due to recurrence of hepatocellular carcinoma. The other two patients are alive with good graft functions. Our experience suggests that reno-varicoportal anastomosis is a useful technique for patients with complete portal vein thrombosis and cryopreserved grafts may be safely used. •Extra-anatomic (reno-varicoportal) portal vein anastomosis is an effective solution for complete portal vein thrombosis.•The postoperative complications of extra-anatomic portal vein anastomosis is reasonable for liver transplantation.•Using cryopreserved vein grafts can be a good solution for countries where donation is limited.