Orthotopic liver transplantation: nonoperative management of early, acute portal vein thrombosis.

We report a case of acute portal vein thrombosis that occurred 1 week after orthotopic liver transplantation in a patient with sclerosing cholangitis. Unlike other patients reported in the literature who were first seen with variceal bleeding or acute hepatic failure, this patient initially had mild clinical signs, consisting of an abnormal prothrombin time, an increase in liver function test values, and enlarging but nonbleeding gastroesophageal varices. Whereas patients with more extreme symptoms often die or require retransplantation, this patient was managed nonoperatively. Spontaneous lysis of the portal vein thrombus occurred over the ensuing 2 weeks. The diagnosis and management of this milder form of early, acute portal vein thrombosis are discussed.