Alternative forms of portal vein revascularization in liver transplant recipients with complex portal vein thrombosis

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dc.authorid0000-0002-1240-7233
dc.contributor.authorFundora, Yiliam
dc.contributor.authorHessheimer, Amelia J.
dc.contributor.authorDel Prete, Luca
dc.contributor.authorMaroni, Lorenzo
dc.contributor.authorLanari, Jacopo
dc.contributor.authorBarrios, Oriana
dc.contributor.authorClarysse, Mathias
dc.contributor.authorFondevila, Constantino
dc.date.accessioned2023-03-27T08:10:22Z
dc.date.available2023-03-27T08:10:22Z
dc.date.issued2023
dc.departmentİstanbul Medipol Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Organ Nakli Ana Bilim Dalı
dc.description.abstractBackground & Aims: Complex portal vein thrombosis (PVT) is a challenge in liver transplantation (LT). Extra-anatomical approaches to portal revascularization, including renoportal (RPA), left gastric vein (LGA), pericholedochal vein (PCA), and cavoportal (CPA) anastomoses, have been described in case reports and series. The RP4LT Collaborative was created to record cases of alternative portal revascularization performed for complex PVT. Methods: An international, observational web registry was launched in 2020. Cases of complex PVT undergoing first LT performed with RPA, LGA, PCA, or CPA were recorded and updated through 12/2021. Results: A total of 140 cases were available for analysis: 74 RPA, 18 LGA, 20 PCA, and 28 CPA. Transplants were primarily performed with whole livers (98%) in recipients with median (IQR) age 58 (49-63) years, model for end-stage liver disease score 17 (14–24), and cold ischemia 431 (360-505) minutes. Post-operatively, 49% of recipients developed acute kidney injury, 16% diuretic-responsive ascites, 9% refractory ascites (29% with CPA, p <0.001), and 10% variceal hemorrhage (25% with CPA, p = 0.002). After a median follow-up of 22 (4-67) months, patient and graft 1-/3-/5-year survival rates were 71/67/61% and 69/63/57%, respectively. On multivariate Cox proportional hazards analysis, the only factor significantly and independently associated with all-cause graft loss was non-physiological portal vein reconstruction in which all graft portal inflow arose from recipient systemic circulation (hazard ratio 6.639, 95% CI 2.159-20.422, p = 0.001). Conclusions: Alternative forms of portal vein anastomosis achieving physiological portal inflow (i.e., at least some recipient splanchnic blood flow reaching transplant graft) offer acceptable post-transplant results in LT candidates with complex PVT. On the contrary, non-physiological portal vein anastomoses fail to resolve portal hypertension and should not be performed. Impact and implications: Complex portal vein thrombosis (PVT) is a challenge in liver transplantation. Results of this international, multicenter analysis may be used to guide clinical decisions in transplant candidates with complex PVT. Extra-anatomical portal vein anastomoses that allow for at least some recipient splanchnic blood flow to the transplant allograft offer acceptable results. On the other hand, anastomoses that deliver only systemic blood flow to the allograft fail to resolve portal hypertension and should not be performed.
dc.description.sponsorshipGuanguong Shunde Innovative Design Institute ; Instituto de Salud Carlos IIIen_US
dc.identifier.citationFundora, Y., Hessheimer, A. J., del Prete, L., Maroni, L., Lanari, J., Barrios, O. ... Fondevila, C. (2023). Alternative forms of portal vein revascularization in liver transplant recipients with complex portal vein thrombosis. Journal of Hepatology, 78(4), 794-804. https://dx.doi.org/10.1016/j.jhep.2023.01.007
dc.identifier.doi10.1016/j.jhep.2023.01.007
dc.identifier.endpage804
dc.identifier.issn0168-8278
dc.identifier.issue4
dc.identifier.pmid36690281
dc.identifier.scopus2-s2.0-85149800421
dc.identifier.scopusqualityQ1
dc.identifier.startpage794
dc.identifier.urihttps://dx.doi.org/10.1016/j.jhep.2023.01.007
dc.identifier.urihttps://hdl.handle.net/20.500.12511/10701
dc.identifier.volume78
dc.identifier.wos000958395300001en_US
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorDayangaç, Murat
dc.language.isoen
dc.publisherElsevier B.V.
dc.relation.ispartofJournal of Hepatologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/embargoedAccess
dc.subjectCavoportal Anastomosis
dc.subjectCavoportal Hemitransposition
dc.subjectLiver Transplantation
dc.subjectMultivisceral Transplantation
dc.subjectPortal Hypertension
dc.subjectPortal Vein Thrombosis
dc.subjectRenoportal Anastomosis
dc.titleAlternative forms of portal vein revascularization in liver transplant recipients with complex portal vein thrombosis
dc.typeArticle

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