Renoportal Anastomosis During Liver Transplantation in Patients With Portal Vein Thrombosis First Long-term Results From a Multicenter Study
Renoportal Anastomosis During Liver Transplantation in Patients With Portal Vein Thrombosis First Long-term Results From a Multicenter Study
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DOI：
10.1097/sla.0000000000004797
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发表时间：
2022-12-01
影响因子：
9
通讯作者：
Lim，Chetana
中科院分区：
文献类型：
--
作者：
Azoulay，Daniel;Quintini，Cristiano;Lim，Chetana
目的：评估RPA在大型多中心系列中的短期和长期结局。摘要背景：目前对弥漫性PVT和大型脾肾分流患者LT期间RPA用于门静脉重建的知识较差，仅限于病例报告和小型病例系列。方法：包括1998年至2020年期间在5个中心进行的所有连续LT与RPA。RPA是生理性的，只要它通过一个大的脾肾分流（直径≥ 1 cm）引流内脏静脉回流。评估PHT的并发症、长期RPA通畅率以及患者和移植物存活率。RPA成功实现了以下3个标准都得到满足：患者是活着的专利RPA和没有临床PHT.Results：RPA是尝试和可行的57例连续51例（89.5%）的生理。5例（8.5%）患者发生了90天死亡，42.9%的患者发生了肺结核相关并发症。中位随访时间为63个月，1年、3年和5年患者和移植物存活率分别为87%、83%和76%以及82%、80%和73%。5年时的一期和一期辅助通畅率分别为84.5%和94.3%。成功率为90%（27/30），随访时间≥ 5年。结论：尽管肺移植相关并发症的发生率很高，但患者和移植物的长期存活率仍然很高。RPA在绝大多数患者中被认为是成功的。扩大RPA的使用是必要的。
Objective:To evaluate the short-and long-term outcomes of RPA in a large multicentric series.Summary Background:The current knowledge on RPA for portal reconstruction during LT in patients with diffuse PVT and a large splenorenal shunt is poor and limited to case reports and small case series.Methods:All consecutive LTs with RPA performed in 5 centers between 1998 and 2020 were included. RPA was physiological provided it drained the splanchnic venous return through a large splenorenal shunt (≥ 1 cm diameter). Complications of PHT, long-term RPA patency, and patient and graft survival were assessed. RPA success was achieved provided the 3 following criteria were all fulfilled: patients were alive with patent RPA and without clinical PHT.Results:RPA was attempted and feasible in 57 consecutive patients and was physiological in 51 patients (89.5%). Ninety-day mortality occurred in 5 (8.5%) patients, and PHT-related complications occurred in 42.9% of patients. With a median follow-up of 63 months, the 1-, 3-and 5-year patient and graft survival rates were 87%, 83%, and 76% and 82%, 80%, and 73%, respectively. The primary and primary-assisted patency rates at 5 years were 84.5% and 94.3%, respectively. Success was achieved in 90%(27/30) of patients with a follow-up≥ 5 years.Conclusions:Despite a high rate of PHT-related complications, excellent long-term patient and graft survival could be achieved. RPA could be considered successful in the vast majority of patients. The expanded use of RPA is warranted.