Miura Kohei, Sugawara Yasuhiko, Uchida Koushi, Kawabata Seiichi, Yoshii Daiki, Isono Kaori, Hayashida Shintaro, Ohya Yuki, Yamamoto Hidekazu, Kobayashi Takashi, Wakai Toshifumi, Inomata Yukihiro, Hibi Taizo
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Transplant Direct. 2018 Apr 13;4(5):e341. doi: 10.1097/TXD.0000000000000780. eCollection 2018 May.
Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) is associated with several technical challenges for its complicated procedures and poor outcomes. Some institutions still consider preexisting PVT as a relatively contraindication for LDLT.
Between April 2010 and May 2016, 129 adults underwent LDLT at our institution, and 28 (21.7%) of whom had preexisting PVT. Portal vein thrombosis was diagnosed using preoperative imaging techniques and intraoperative findings. The characteristics and outcomes of the cases were retrospectively evaluated.
The type of PVT included Yerdel grade 1 in 21 (75.0%) cases, grade 2 in 3 (10.7%) cases, and grade 3 in 4 (14.3%) cases. There were no cases of Yerdel grade 4 PVT. After removing thrombus inside the vessel, we performed simple portal vein anastomosis in 25 (89.3%) cases, patch technique with vascular graft in 1 case (3.6%), and an interposition technique with vascular graft in 2 cases (7.1%). Compared with the non-PVT group, cold ischemic time was longer ( = 0.012) and the rate of postoperative PVT was higher ( = 0.001) in PVT group. In the comparison between the recipient without and with postoperative PVT, the existence of preoperative PVT was the independent risk factor in the multivariate analysis (hazard ratio, 7.511; 95% confidence interval 1.382-40.820; = 0.020).
Although it had a technically complicated operation, LDLT could be safely performed in the patients with PVT in our institution.
门静脉血栓形成（PVT）患者的活体肝移植（LDLT）因其手术过程复杂且预后不佳而面临多项技术挑战。一些机构仍将既往存在的PVT视为LDLT的相对禁忌证。
2010年4月至2016年5月期间，129例成人在我院接受了LDLT，其中28例（21.7%）既往存在PVT。采用术前影像学技术和术中发现诊断门静脉血栓形成。对病例的特征和结果进行回顾性评估。
PVT类型包括Yerdel 1级21例（75.0%）、2级3例（10.7%）、3级4例（14.3%）。无Yerdel 4级PVT病例。在清除血管内血栓后，25例（89.3%）采用简单门静脉吻合术，1例（3.6%）采用血管移植物补片技术，2例（7.1%）采用血管移植物间置技术。与非PVT组相比，PVT组冷缺血时间更长（P = 0.012），术后PVT发生率更高（P = 0.001）。在接受者有无术后PVT的比较中，术前PVT的存在是多因素分析中的独立危险因素（风险比，7.511；95%置信区间1.382 - 40.820；P = 0.020）。
尽管手术技术复杂，但在我院，LDLT可在PVT患者中安全进行。
