Preoperative portal vein recanalization-transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation.
Preoperative portal vein recanalization-transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation.
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DOI：
10.1002/hep4.1914
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发表时间：
2022-07
影响因子：
5.1
通讯作者：
中科院分区：
文献类型：
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作者：
高度门静脉血栓形成（PVT）通常被认为是肝移植（LT）的技术挑战，在某些中心是相对禁忌症。本研究比较了接受门静脉再通-经颈静脉肝内门体分流术（PVR‐TIPS）和随后LT的慢性闭塞性PVT患者与接受LT但未接受干预的部分非闭塞性PVT患者。这项机构审查委员会批准的研究分析了我们机构2000年至2020年的49例肝硬化PVT患者。将患者分为两组，由于慢性闭塞性PVT的预期手术挑战而接受PVR‐TIPS的患者和由于部分PVT而未接受PVR‐TIPS的患者。比较人口统计学数据和长期结局。共有35名患者接受了PVR‐TIPS，而14名患者没有接受，所有患者都接受了LT。与未接受PVR‐TIPS的患者相比，PVR‐TIPS患者的Yerdel评分和海绵状血管瘤发生率较高。PVR‐TIPS可有效降低门体静脉压差（16降至8 mm HG; p < 0.05）。两组均允许>90%的病例发生端到端的并发症。然而，静脉-静脉旁路术在未接受PVR‐TIPS的患者中的使用率明显更高。此外，无PVR‐TIPS的患者需要显著更多的术中红细胞。两组的总生存率没有差异。PVR-TIPS证实了解决PVT的有效性，并允许端对端门静脉闭塞。PVR‐TIPS是慢性闭塞性PVT（伴或不伴海绵状血管瘤）的可行治疗选择，简化了LT的手术方面。慢性闭塞性门静脉血栓形成患者在门静脉再通-经颈静脉肝内门体分流术（PVR‐TIPS）后可能转为肝移植候选人。慢性闭塞性门静脉血栓形成患者在PVR-TIPS后接受移植的长期生存结局与轻度门静脉血栓形成患者在无干预的情况下接受常规移植的长期生存结局相似。
High‐grade portal vein thrombosis (PVT) is often considered to be a technically challenging scenario for liver transplantation (LT) and in some centers a relative contraindication. This study compares patients with chronic obliterative PVT who underwent portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR‐TIPS) and subsequent LT to those with partial nonocclusive PVT who underwent LT without an intervention. This institutional review board‐approved study analyzed 49 patients with cirrhosis with PVT from 2000 to 2020 at our institution. Patients were divided into two groups, those that received PVR‐TIPS due to anticipated surgical challenges from chronic obliterative PVT and those who did not because of partial PVT. Demographic data and long‐term outcomes were compared. A total of 35 patients received PVR‐TIPS while 14 did not, with all receiving LT. Patients with PVR‐TIPS had a higher Yerdel score and frequency of cavernoma than those that did not. PVR‐TIPS was effective in decreasing portosystemic gradient (16 down to 8 mm HG; p < 0.05). Both groups allowed for end‐to‐end anastomoses in >90% of cases. However, veno–veno bypass was used significantly more in patients who did not receive PVR‐TIPS. Additionally, patients without PVR‐TIPS required significantly more intraoperative red blood cells. Overall survival was not different between groups. PVR‐TIPS demonstrated efficacy in resolving PVT and allowed for end‐to‐end portal vein anastomoses. PVR‐TIPS is a viable treatment option for chronic obliterative PVT with or without cavernoma that simplifies the surgical aspects of LT. Patients with chronic, obliterative portal vein thrombosis may be converted to liver transplantation candidacy following portal vein recanalization‐transjugular intrahepatic portosystemic shunt (PVR‐TIPS). Long‐term survival outcomes of patients with chronic, obliterative portal vein thrombosis who undergo transplantation following PVR‐TIPS are similar to those with mild portal vein thrombosis that undergo routine transplantation without intervention.
影响因子：
1.7
作者：
Manzia, Tommaso Maria;Fazzolari, Laura;Manuelli, Matteo;Pellicciaro, Marco;Baiocchi, Leonardo;Tisone, Giuseppe
通讯作者：
Tisone, Giuseppe