Imai H, Egawa H, Kajiwara M, Nakajima A, Ogura Y, Hatano E, Ueda M, Kawaguchi Y, Kaido T, Takada Y, Uemoto S
Department of Hepatobiliary Pancreas and Transplant Surgery, Kyoto University, Kyoto, Japan.
Transplant Proc. 2009 Nov;41(9):3931-3. doi: 10.1016/j.transproceed.2008.10.104.
A 59-year-old man with hepatitis C virus-associated liver cirrhosis was transferred to our hospital to undergo living donor liver transplantation. Coagulation was impaired (prothrombin time [International Normalized Ratio], 3.27), and antithrombin III (AT-III) activity was 23% (normal, 87%-115%). Contrast-enhanced computed tomography scans revealed portal vein thrombosis (PVT) from the junction between the splenic and superior mesenteric vein to the porta hepatica; the portal vein was completely obstructed (PVT). To prevent further development of PVT, 1500 U of AT-III was administered for 3 days, elevating the AT-III activity to 50%. A contrast-enhanced computed tomography scan obtained 9 days after AT-III administration showed resolution of PVT. Living donor liver transplantation was safely performed without portal vein grafting. Thus, a low AT-III concentration may have an important role in the pathogenesis of PVT in patients with cirrhosis.
