Wu Tsung-Han, Lin Yann-Sheng, Lee Chen-Fang, Wu Ting-Jung, Yu Ming-Chin, Chan Kun-Ming, Lee Wei-Chen
Department of General Surgery; Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2011 Jul-Aug;34(4):426-34.
Liver transplantation (LT) in patients with portal vein thrombosis (PVT) remains a challenge for transplant surgeons. In this study, we included a group of patients with PVT who underwent LT, and analyzed patient outcomes.
A total of 356 patients who underwent LT consisting of 167 cases of deceased donor LT and 189 cases of live donor LT at Chang Gung Memorial Hospital Linkou Medical Center between September 1996 and June 2009 were retrospectively reviewed; 24 (6.7%) of these patients had PVT at transplantation. Their clinical features, surgical management, and outcomes were analyzed.
Surgical management of patients with PVT included a thrombectomy followed by direct anastomosis between the recipient's and the liver graft portal vein (PV) (n = 13), interposition vein graft between the recipient's coronary vein (CV) and the liver graft PV (n = 3), direct anastomosis of the recipient's CV and the liver graft PV (n = 1), interposition jump graft from the recipient's superior mesenteric vein to the liver graft PV (n = 4), and transection of the thrombotic PV followed by interposition of a venous graft between the recipient's PV and the liver graft PV (n = 3). There were 7 hospital mortalities. The mean follow-up for the 17 surviving patients was 36.3 months (range, 3.4-105.1 months), and 14 patients were still alive at the end of the study. Four patients (16.7%) had rethrombosis of portal inflow after LT. Patients with PVT undergoing LT had a significantly higher mortality rate (p = 0.033) than patients without PVT undergoing LT. However, there was no significant difference in the cumulative survival rates (p = 0.0696). Further analysis of patient survival according to PVT grade, venous graft application, and reconstructed portal flow routes also exhibited no significant differences.
LT for patients with PVT is clinically feasible and should not be considered a contraindication. However, a favorable outcome is achievable only with ideal surgical management to overcome PVT during LT.
门静脉血栓形成（PVT）患者的肝移植（LT）对移植外科医生来说仍然是一项挑战。在本研究中，我们纳入了一组接受LT的PVT患者，并分析了患者的预后情况。
回顾性分析了1996年9月至2009年6月在长庚纪念医院林口医学中心接受LT的356例患者，其中包括167例尸体供肝LT和189例活体供肝LT；这些患者中有24例（6.7%）在移植时患有PVT。分析了他们的临床特征、手术处理方法及预后情况。
PVT患者的手术处理方法包括血栓切除术，然后在受体与肝移植门静脉（PV）之间进行直接吻合（n = 13）；在受体冠状静脉（CV）与肝移植PV之间置入静脉移植物（n = 3）；受体CV与肝移植PV直接吻合（n = 1）；从受体肠系膜上静脉到肝移植PV进行跨位跳跃式移植物置入（n = 4）；横断血栓形成的PV，然后在受体PV与肝移植PV之间置入静脉移植物（n = 3）。有7例患者在医院死亡。17例存活患者的平均随访时间为36.3个月（范围为3.4 - 105.1个月），研究结束时14例患者仍存活。4例患者（16.7%）在LT后发生门静脉流入道再血栓形成。接受LT的PVT患者的死亡率显著高于未发生PVT接受LT的患者（p = 0.033）。然而，累积生存率无显著差异（p = 0.0696）。根据PVT分级、静脉移植物应用及重建门静脉血流途径对患者生存情况进行的进一步分析也未显示出显著差异。
PVT患者的LT在临床上是可行的，不应被视为禁忌证。然而，只有通过理想的手术处理方法在LT期间克服PVT才能取得良好的预后。
