Tao Yi-Feng, Teng Fei, Wang Zheng-Xin, Guo Wen-Yuan, Shi Xiao-Min, Wang Gui-Hua, Ding Guo-Shan, Fu Zhi-Ren
Organ Transplantation Center, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Hepatobiliary Pancreat Dis Int. 2009 Feb;8(1):34-9.
Portal vein thrombosis (PVT) used to be a contraindication for liver transplantation (LT). This obstacle has been delt with following the improvement of LT-related techniques and therapeutic approaches to thrombosis. But the effect of PVT on LT outcomes is still controversial. We reviewed retrospectively the outcome of LT patients with PVT as well as risk factors and surgical management according to PVT grades.
A total of 465 adult LTs were performed from December 2002 through December 2006. Operative findings and the result of preoperative ultrasonography and imaging were reviewed for PVT grading (Yerdel grading). Comparison of risk factors, variables associated with perioperative period and prognosis between recipients with and without PVT is based on the grades.
In the 465 LTs, 42 were operatively confirmed to have PVT (9.0%) (19 recipients with grade 1, 14 with grade 2, 7 with grade 3, and 2 with grade 4). Increased age and treatment of portal hypertension were associated with PVT. Grade 1 or 2 PVT was treated by direct anastomosis or single thrombectomy. In grade 3 PVT patients, the donor PV was directly anastomosed to the dilated branch of the recipient portal venous system or to the distal open superior mesenteric vein through an interposition vein graft if needed. Grade 4 PVT was managed by our modified cavoportal hemitransposition technique. The comparison between PVT patients and controls showed no significant difference in operative duration and blood transfusion (P>0.05). The flow rate of the PV was lower in the PVT patients (48.881+/-12.788 cm/s) than in the controls (57.172+/-21.715 cm/s, P<0.05). The PVT patients had such postoperative complications as renal failure and PV rethrombosis (P<0.05). The 1-year survival rates in PVT and non-PVT patients were 78.6% and 76.4% respectively (P>0.05); the 3-year survival rates were 58.8% and 56.4% respectively (P>0.05).
PVT is not contraindicated for LT if it is graded. PVT recipients may have post-transplantation complications like renal failure and PV rethrombosis, and operative difficulty and patient survival are similar to those in recipients without PVT. Development of therapeutic approaches and accumulation of experience in dealing with PVT further improve the outcomes of LT in PVT recipients.
门静脉血栓形成（PVT）曾是肝移植（LT）的禁忌证。随着LT相关技术及血栓治疗方法的改进，这一障碍已得到解决。但PVT对LT预后的影响仍存在争议。我们回顾性分析了PVT患者肝移植的预后情况以及根据PVT分级的危险因素和手术处理方法。
2002年12月至2006年12月共进行了465例成人肝移植手术。回顾手术所见以及术前超声和影像学检查结果以进行PVT分级（耶德尔分级）。根据分级比较有无PVT受者的危险因素、围手术期相关变量及预后情况。
在465例肝移植中，42例术中证实存在PVT（9.0%）（19例1级受者，14例2级受者，7例3级受者，2例4级受者）。年龄增加和门静脉高压治疗与PVT相关。1级或2级PVT采用直接吻合或单纯血栓切除术治疗。对于3级PVT患者，如果需要，将供体门静脉直接吻合至受者门静脉系统的扩张分支或通过间置静脉移植物吻合至远端开放的肠系膜上静脉。4级PVT采用我们改良的腔门静脉半转位技术处理。PVT患者与对照组相比，手术时间和输血量无显著差异（P>0.05）。PVT患者门静脉血流速度（48.881±12.788 cm/s）低于对照组（57.172±21.715 cm/s，P<0.05）。PVT患者术后出现肾衰竭和门静脉再血栓形成等并发症（P<0.05）。PVT患者和非PVT患者术后1年生存率分别为78.6%和76.4%（P>0.05）；3年生存率分别为58.8%和56.4%（P>0.05）。
如果对PVT进行分级，其并非肝移植的禁忌证。PVT受者术后可能出现肾衰竭和门静脉再血栓形成等并发症，手术难度和患者生存率与无PVT受者相似。治疗方法的发展和处理PVT经验的积累进一步改善了PVT受者肝移植的预后。
