Pinelli Domenico, Cescon Matteo, Ravaioli Matteo, Neri Flavia, Amaduzzi Annalisa, Serenari Matteo, Carioli Greta, Siniscalchi Antonio, Colledan Michele
Department of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Hepatobiliary and Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, 40138 Bologna, Italy.
J Clin Med. 2023 Mar 23;12(7):2457. doi: 10.3390/jcm12072457.
Surgical strategies for graft portal vein flow restoration vary from termino-terminal portal vein anastomosis to more complex bypass reconstructions. Although the surgical strategy strongly influences the post-operative outcome, the Yerdel grading is still commonly used to determine the prognosis of patients with portal vein thrombosis (PVT) undergoing liver transplantation (LT). We retrospectively reviewed the cases of LT performed on recipients with complex PVT at two high-volume transplantation centres. We stratified the patients by the type of portal vein reconstruction, termino-terminal portal vein anastomosis (TTA) versus bypass reconstruction (bypass group), and assessed a multivariable survival analysis. The rate of mortality at 90 days was 21.4% for the bypass group compared to 9.8% in the TTA group ( = 0.05). In the multivariable correlation analysis, only a trend for greater risk of early mortality was confirmed in the bypass groups (HR 2.5; = 0.059). Yerdel grade was uninfluential in the rate of early complications. A wide range of surgical options are available for different situations of PVT which yield an outcome unrelated to the Yerdel grading. An algorithm for PVT management should be based on the technical approach and should include a surgically oriented definition of PVT extension.
恢复移植门静脉血流的手术策略各不相同，从端端门静脉吻合到更复杂的搭桥重建。尽管手术策略对术后结果有很大影响，但耶德尔分级仍常用于确定接受肝移植（LT）的门静脉血栓形成（PVT）患者的预后。我们回顾性分析了两个高容量移植中心对患有复杂PVT的受者进行LT的病例。我们根据门静脉重建类型将患者分层，端端门静脉吻合（TTA）与搭桥重建（搭桥组），并进行多变量生存分析。搭桥组90天死亡率为21.4%，而TTA组为9.8%（P = 0.05）。在多变量相关性分析中，仅在搭桥组中证实了早期死亡风险更高的趋势（风险比2.5；P = 0.059）。耶德尔分级对早期并发症发生率没有影响。对于不同情况的PVT，有多种手术选择，其结果与耶德尔分级无关。PVT管理算法应基于技术方法，并应包括以手术为导向的PVT扩展定义。
