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The portal vein thrombosis (PVT) in candidates for liver transplantation, until the recent past, was considered an absolute contraindication to transplantation because of technical difficulties and high mortality. This study will assess outcome and prognosis in the patients with portal vein thrombosis of different grades and will undergo living donor liver transplantation.
Portal vein thrombosis (PVT) is a common complication of end-stage liver disease with an incidence of 0.6‒16% in patients with well-compensated disease, increasing up to 35% in cirrhotic patients with hepatocellular carcinoma.
from a clinical point of view, there are two types of PVT;Acute: sudden formationof a thrombus within the portal vein, which was not detectedduringthe previous biannual ultrasound. Occlusion may be complete or partial.Chronic (portal cavernoma): replacement of the normal portal vein by a network ofhepatopetal collateral veins. It functions as a portoportalshunt.
All patients with confirmed PVT were retrospectively classified into four grades according to the extent of thromboses: Grade I: minimally or partially thrombosed PV, in which thethrombus is mild or, at the most, confined to ＜50% of the vessel lumen with or withoutminimal extension intothe superiormesenteric vein (SMV). Grade II showed ＞50%occlusion of the PV, including total occlusion with or without minimal extension into the SMV. Grade III were complete thromboses of both PV and proximal SMV with an opendistal SMV. Grade IV was complete thrombosis ofthe portal veinas well as the proximal and distal SMV.
Most patients with cirrhosis are diagnosed with asymptomatic PVT during routine ultrasound. The sensitivity and specificity of Doppler ultrasound are 89% and 92%, respectively, so it is the primary method of choice in this context. If Doppler ultrasound shows portal vein patency, no further studies are indicated.
Enhanced computed tomography and magnetic resonance imaging are the best methods to assess the extent of the PVT. In addition, they provide information about the development of collateral circulation, the status of adjacent organs, and are indicated if intestinal ischaemia or HCC are suspected.
As adequate portal vein (PV) flow is essential for proper liver graft function following reports have introducedsurgical procedures transplantation, many such as thrombectomy, jump graft implantation, renoportal anastomosis,porto caval hemitransposition, and PV arterialization to ensuresufficient portal blood flow to liver grafts.
The separation between occlusive and non-occlusive thrombosis is very important; in patients with partial PVT, post-transplant mortality outcomes are no different from non-PVT patients but it is significantly increased in patients with complete PVT.
Thromboendovenectomy was suggested as the surgical technique of choice for PVT grade 1, 2. If PVT obstruct more extended parts of the porto-mesenteric venous venous circulation grade 3, 4 surgical options would include different types of venous jump graft reconstruction. Recently cavoportal hemitransposition (CPHT) was particularly advocated as creative surgical strategies in case of diffuse PVT to secure the portal flow to the liver graft.
The outcomes of patients with PVT who underwent LDLT are inferior to those without PVT. Patients with PVT has lower survival rate, higher postoperative PV rethrombosis.