Classification and management of portal vein thrombosis during liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHU Zhijun

Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P. R. China;

Corresponding author：

ZHU Zhijun, Email: zhu-zhijun@outlook.com

Keywords：

portal vein thrombosis; thrombosis classification; liver transplantation; portal vein anastomosis; portal hypertension

DOI：

10.7507/1007-9424.202204001

Video：

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Portal vein blood flow is very important for the normal function of transplanted liver. The author reviewed the management methods of different portal vein thrombosis classification in the liver transplantation (LT). The prognosis of LT in the patients with Yerdel 1–3 thrombosis is similar to that the patients without thrombosis. The portal vein reconstruction of the patients with Yerdel 4 thrombosis can be realized by varicose vein to portal anastomosis, renoportal anastomosis or cavoportal hemitransposition. When anastomosis is made at the proximal side of a spontaneous shunt between the portal and cava system, the blood shunted from portal system can be reintroduced into the donor liver, which is crucial for the management of Yerdel 4 thrombosis. The establishments of artificial shunt by distal splenic vein, mesenteric vein or “multiple to one” anastomosis are effective attempts to drain the blood from portal system to the donor liver. For more severe diffuse thrombosis of portal vein system, multivisceral transplantation, including liver and small intestine, should be considered. The cases of LT in the patients with complex portal vein thrombosis are increasing, however the prognosis remains to be determined after accumulation of the cases.

Citation： ZHU Zhijun. Classification and management of portal vein thrombosis during liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 841-844. doi: 10.7507/1007-9424.202204001 Copy

1.	Rodríguez-Castro KI, Porte RJ, Nadal E, et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation, 2012, 94(11): 1145-1153.
2.	Ponziani FR, Zocco MA, Senzolo M, et al. Portal vein thrombosis and liver transplantation: implications for waiting list period, surgical approach, early and late follow-up. Transplant Rev (Orlando), 2014, 28(2): 92-101.
3.	Chen H, Turon F, Hernández-Gea V, et al. Nontumoral portal vein thrombosis in patients awaiting liver transplantation. Liver Transpl, 2016, 22(3): 352-365.
4.	Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation, 2016, 100(1): 126-133.
5.	Bettinger D, Sturm L, Pfaff L, et al. Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. J Hepatol, 2021, 74(6): 1362-1372.
6.	Bhangui P, Lim C, Levesque E, et al. Novel classification of non-malignant portal vein thrombosis: a guide to surgical decision-making during liver transplantation. J Hepatol, 2019, 71(5): 1038-1050.
7.	Stieber AC, Zetti G, Todo S, et al. The spectrum of portal vein thrombosis in liver transplantation. Ann Surg, 1991, 213(3): 199-206.
8.	Nonami T, Yokoyama I, Iwatsuki S, et al. The incidence of portal vein thrombosis at liver transplantation. Hepatology, 1992, 16(5): 1195-1198.
9.	Gayowski TJ, Marino IR, Doyle HR, et al. A high incidence of native portal vein thrombosis in veterans undergoing liver transplantation. J Surg Res, 1996, 60(2): 333-338.
10.	Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation, 2000, 69(9): 1873-1881.
11.	Jamieson NV. Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation, 2000, 69(9): 1772-1774.
12.	Charco R, Fuster J, Fondevila C, et al. Portal vein thrombosis in liver transplantation. Transplant Proc, 2005, 37(9): 3904-3905.
13.	Bauer J, Johnson S, Durham J, et al. The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis. Liver Transpl, 2006, 12(10): 1544-1551.
14.	Ma J, Yan Z, Luo J, et al. Rational classification of portal vein thrombosis and its clinical significance. PloS One, 2014, 9 (11): e112501. doi: 10.1371/journal.pone.0112501.
15.	Sarin SK, Philips CA, Kamath PS, et al. Toward a comprehensive new classification of portal vein thrombosis in patients with cirrhosis. Gastroenterology, 2016, 151(4): 574-577. e3. doi: 10.1053/j.gastro.2016.08.033.
16.	Ravaioli M, Zanello M, Grazi GL, et al. Portal vein thrombosis and liver transplantation: evolution during 10 years of experience at the University of Bologna. Ann Surg, 2011, 253(2): 378-384.
17.	Zanetto A, Rodriguez-Kastro KI, Germani G, et al. Mortality in liver transplant recipients with portal vein thrombosis—an updated meta-analysis. Transpl Int, 2018, 31(12): 1318-1329.
18.	Palazzo L, Hochain P, Helmer C, et al. Biliary varices on endoscopic ultrasonography: clinical presentation and outcome. Endoscopy, 2000, 32(7): 520-524.
19.	Simon-Talero M, Roccarina D, Martinez J, et al. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis. Gastroenterology, 2018, 154(6): 1694-1705. e4. doi: 10.1053/j.gastro.2018.01.028.
20.	Gomez Gavara C, Bhangui P, Salloum C, et al. Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: audit of a prospective series of 66 consecutive patients. Liver Transpl, 2018, 24(4): 505-515.
21.	Sheil AG, Stephen MS, Chui AK, et al. A liver transplantation technique in a patient with a thrombosed portal vein and a functioning renal-lieno shunt. Clin Transplant, 1997, 11(1): 71-73.
22.	朱志军, 蔡金贞, 孟醒初, 等. 肝移植中合并门静脉血栓的诊断及处理. 中华肝胆外科杂志, 2004, 10(7): 473-475.
23.	朱志军, 淮明生, 张雅敏, 等. 肝移植术中受者左肾静脉与供肝门静脉吻合一例及文献复习. 中华器官移植杂志, 2007, 28(6): 365-367.
24.	D’Amico G, Matsushima H, Del Prete L, et al. Long term outcomes and complications of reno-portal anastomosis in liver transplantation: results from a propensity score-based outcome analysis. Transpl Int, 2021, 34(10): 1938-1947.
25.	Kim HB, Pomposelli JJ, Lillehei CW, et al. Mesogonadal shunts for extrahepatic portal vein thrombosis and variceal hemorrhage. Liver Transpl, 2005, 11(11): 1389-1394.
26.	Azoulay D, Lahat E, Salloum C, et al. Heterotopic liver retransplantation for impossible former graft explantation. Hepatology, 2017, 66(2): 655-657.
27.	Vianna RM, Mangus RS, Kubal C, et al. Multivisceral transplantation for diffuse portomesenteric thrombosis. Ann Surg, 2012, 255(6): 1144-1150.

1. Rodríguez-Castro KI, Porte RJ, Nadal E, et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation, 2012, 94(11): 1145-1153.
2. Ponziani FR, Zocco MA, Senzolo M, et al. Portal vein thrombosis and liver transplantation: implications for waiting list period, surgical approach, early and late follow-up. Transplant Rev (Orlando), 2014, 28(2): 92-101.
3. Chen H, Turon F, Hernández-Gea V, et al. Nontumoral portal vein thrombosis in patients awaiting liver transplantation. Liver Transpl, 2016, 22(3): 352-365.
4. Ghabril M, Agarwal S, Lacerda M, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation, 2016, 100(1): 126-133.
5. Bettinger D, Sturm L, Pfaff L, et al. Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. J Hepatol, 2021, 74(6): 1362-1372.
6. Bhangui P, Lim C, Levesque E, et al. Novel classification of non-malignant portal vein thrombosis: a guide to surgical decision-making during liver transplantation. J Hepatol, 2019, 71(5): 1038-1050.
7. Stieber AC, Zetti G, Todo S, et al. The spectrum of portal vein thrombosis in liver transplantation. Ann Surg, 1991, 213(3): 199-206.
8. Nonami T, Yokoyama I, Iwatsuki S, et al. The incidence of portal vein thrombosis at liver transplantation. Hepatology, 1992, 16(5): 1195-1198.
9. Gayowski TJ, Marino IR, Doyle HR, et al. A high incidence of native portal vein thrombosis in veterans undergoing liver transplantation. J Surg Res, 1996, 60(2): 333-338.
10. Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation, 2000, 69(9): 1873-1881.
11. Jamieson NV. Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation, 2000, 69(9): 1772-1774.
12. Charco R, Fuster J, Fondevila C, et al. Portal vein thrombosis in liver transplantation. Transplant Proc, 2005, 37(9): 3904-3905.
13. Bauer J, Johnson S, Durham J, et al. The role of TIPS for portal vein patency in liver transplant patients with portal vein thrombosis. Liver Transpl, 2006, 12(10): 1544-1551.
14. Ma J, Yan Z, Luo J, et al. Rational classification of portal vein thrombosis and its clinical significance. PloS One, 2014, 9 (11): e112501. doi: 10.1371/journal.pone.0112501.
15. Sarin SK, Philips CA, Kamath PS, et al. Toward a comprehensive new classification of portal vein thrombosis in patients with cirrhosis. Gastroenterology, 2016, 151(4): 574-577. e3. doi: 10.1053/j.gastro.2016.08.033.
16. Ravaioli M, Zanello M, Grazi GL, et al. Portal vein thrombosis and liver transplantation: evolution during 10 years of experience at the University of Bologna. Ann Surg, 2011, 253(2): 378-384.
17. Zanetto A, Rodriguez-Kastro KI, Germani G, et al. Mortality in liver transplant recipients with portal vein thrombosis—an updated meta-analysis. Transpl Int, 2018, 31(12): 1318-1329.
18. Palazzo L, Hochain P, Helmer C, et al. Biliary varices on endoscopic ultrasonography: clinical presentation and outcome. Endoscopy, 2000, 32(7): 520-524.
19. Simon-Talero M, Roccarina D, Martinez J, et al. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis. Gastroenterology, 2018, 154(6): 1694-1705. e4. doi: 10.1053/j.gastro.2018.01.028.
20. Gomez Gavara C, Bhangui P, Salloum C, et al. Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: audit of a prospective series of 66 consecutive patients. Liver Transpl, 2018, 24(4): 505-515.
21. Sheil AG, Stephen MS, Chui AK, et al. A liver transplantation technique in a patient with a thrombosed portal vein and a functioning renal-lieno shunt. Clin Transplant, 1997, 11(1): 71-73.
22. 朱志军, 蔡金贞, 孟醒初, 等. 肝移植中合并门静脉血栓的诊断及处理. 中华肝胆外科杂志, 2004, 10(7): 473-475.
23. 朱志军, 淮明生, 张雅敏, 等. 肝移植术中受者左肾静脉与供肝门静脉吻合一例及文献复习. 中华器官移植杂志, 2007, 28(6): 365-367.
24. D’Amico G, Matsushima H, Del Prete L, et al. Long term outcomes and complications of reno-portal anastomosis in liver transplantation: results from a propensity score-based outcome analysis. Transpl Int, 2021, 34(10): 1938-1947.
25. Kim HB, Pomposelli JJ, Lillehei CW, et al. Mesogonadal shunts for extrahepatic portal vein thrombosis and variceal hemorrhage. Liver Transpl, 2005, 11(11): 1389-1394.
26. Azoulay D, Lahat E, Salloum C, et al. Heterotopic liver retransplantation for impossible former graft explantation. Hepatology, 2017, 66(2): 655-657.
27. Vianna RM, Mangus RS, Kubal C, et al. Multivisceral transplantation for diffuse portomesenteric thrombosis. Ann Surg, 2012, 255(6): 1144-1150.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Classification and management of portal vein thrombosis during liver transplantation

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