Liver Transplant in Patients With Portal Vein Thrombosis: The Experience of 55 Patients.
Liver Transplant in Patients With Portal Vein Thrombosis: The Experience of 55 Patients.
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DOI：
10.6002/ect.2018.0260
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发表时间：
2019-05-08
期刊：
影响因子：
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通讯作者：
Emiroglu, Remzi
中科院分区：
文献类型：
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作者：
Ozer, Ali;Aktas, Hikmet;Emiroglu, Remzi
提示：门静脉血栓形成不再是肝移植的禁忌症。然而，不同的结果仍然报道关于完全门静脉血栓形成的患者。材料和方法：我们分析了2014年1月至2017年6月期间接受肝移植的505例患者的数据。在505例患者中，55例（10.9%）发生门静脉血栓形成，其中37例（67%）为活体供肝，18例（33%）为死亡供肝。根据Yerdel分级，I级5例（9%），II级28例（51%），III级12例（22%），IV级10例（18%）。43例患者门静脉流入通畅（93.5%），但3例患者（6.5%）需要在移植后第1天进行第二次血栓切除术。在10例IV级门静脉血栓形成患者中，9例（16%）接受了解剖外门静脉吻合术。在这9例患者中，7例（77.7%）在术后早期显示门静脉流入通畅。中位随访时间为15.5 ± 13.1个月。在此期间，5例患者检测到门静脉狭窄。死亡供体肝移植患者和活体肝移植患者再次血栓形成的风险没有显著差异。有和无门静脉血栓形成患者的总体患者生存率分别为73%（40/55）和84%（376/450），显示出显著差异（P = 0.05）。结论：与早期门静脉血栓形成相比，完全门静脉血栓形成仍然是肝移植受者的高发病率和不良早期结局的治疗挑战。
OBJECTIVES: Portal vein thrombosis is no longer a contraindication for liver transplantation. However, varied outcomes are still reported with regard to patients with complete portal vein thrombosis.MATERIALS AND METHODS: We analyzed data of 505 patients who underwent liver transplant between January 2014 and June 2017. Of 505 patients, 55 (10.9%) had portal vein thrombosis, which included 37 patients (67%) who had living-donor and 18 patients (33%) who had deceased-donor liver transplant. According to Yerdel classification, 5 (9%), 28 (51%), 12 (22%), and 10 patients (18%) had grade I, II, III, and IV portal vein thrombosis, respectively.RESULTS: Thrombectomy was successful in 46 patients (84%). Forty-three patients had patent portal inflow (93.5%), but 3 patients (6.5%) required a second thrombectomy on day 1 posttransplant. Of 10 patients with grade IV portal vein thrombosis, 9 (16%) underwent extra-anatomic portal vein anastomosis. Of these 9 patients, 7 (77.7%) showed patent portal inflow during the early postoperative period. Median follow-up time was 15.5 ± 13.1 months. During this time, portal vein stenosis was detected in 5 patients. Risk of repeat thrombosis was not significantly different between patients with deceased-donor and patients with living-donor liver transplant. Overall patient survival rates for patients with and without portal vein thrombosis were 73% (40/55) and 84% (376/450), respectively, which showed significant difference (P = .05).CONCLUSIONS: In contrast to early-grade portal vein thrombosis, complete portal vein thrombosis still provides a treatment challenge with high risk of morbidity and poor early outcomes in liver transplant recipients.