Levi Sandri Giovanni Battista, Lai Quirino, Berloco Pasquale B, Rossi Massimo
Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy.
Exp Clin Transplant. 2014 Jun;12(3):238-40.
Portal vein thrombosis may complicate liver transplant. The purpose of this study was to analyze our cohort of transplanted recipients to evaluate the relation between preoperative portal vein thrombosis and patient and graft survival after liver transplant.
We retrospectively analyzed 209 patients who had liver transplant; 2 patients who had the diagnosis of portal vein thrombosis made during surgery were excluded. Patients were stratified in 2 groups according to whether they had (15 patients) or did not have portal vein thrombosis (192 patients) before liver transplant and were compared for early and late survival.
In all 15 patients who had portal vein thrombosis, the Yerdel grade was I or II. Patients who had preoperative portal vein thrombosis had lower median survival (portal vein thrombosis, 47 mo; no portal vein thrombosis, 61 mo), frequency of total number of deaths (portal vein thrombosis, 4 [27%]; no portal vein thrombosis, 68 [35%]), and frequency of death within 3 months after transplant (portal vein thrombosis, 1 [7%]; no portal vein thrombosis, 23 [12%]). However, there was no significant difference between the 2 groups in patient or graft survival.
Low-grade portal vein thrombosis detected before liver transplant is not an absolute contraindication for liver transplant. Radiographic screening before liver transplant is recommended to minimize surgical difficulty.
门静脉血栓形成可能会使肝移植变得复杂。本研究的目的是分析我们的移植受者队列，以评估术前门静脉血栓形成与肝移植后患者及移植物存活之间的关系。
我们回顾性分析了209例接受肝移植的患者；排除了2例在手术期间被诊断为门静脉血栓形成的患者。根据肝移植前是否存在门静脉血栓形成（15例患者），将患者分为两组（192例患者），并比较早期和晚期存活率。
在所有15例存在门静脉血栓形成的患者中，耶德尔分级为I级或II级。术前存在门静脉血栓形成的患者的中位生存期较低（门静脉血栓形成组为47个月；无门静脉血栓形成组为61个月），总死亡频率（门静脉血栓形成组为4例[27%]；无门静脉血栓形成组为68例[35%]），以及移植后3个月内的死亡频率（门静脉血栓形成组为1例[7%]；无门静脉血栓形成组为23例[12%]）。然而，两组在患者或移植物存活方面没有显著差异。
肝移植前检测到的低度门静脉血栓形成并非肝移植的绝对禁忌证。建议在肝移植前进行影像学筛查，以尽量减少手术难度。
