Improved results of liver transplantation in patients with portal vein thrombosis

Objective: To analyze the impact of preexisting portal vein thrombosis (PVT) on the operative management and outcome of liver transplantation. Design: Retrospective review of 1423 patients who received transplants over 11 years. Setting: Tertiary referral center. Patients or Other Participants: Seventy patients who underwent liver transplantation who had preexisting PVT. Interventions: Portal vein thromboendovenectomy, vein grafting, or use of portal collateral veins for inflow during liver transplantation. Main Outcome Measures: Postoperative PVT, intraoperative transfusion, retransplantation rate, 30-day and 1-year actuarial survival tales. Results: Operative management consisted of thromboendovenectomy in 61 cases, vein graft to the superior mesenteric vein in 6 cases, and vein graft to other mesenteric veins in 3 cases. The incidence of posttransplant PVT was 3% (n=2). The mean±SD transfusion requirement was 23±18 U. The 1-year actuarial survival rate was 74% but improved from 66% in the first 35 cases to 82% in the latter 35 cases. Conclusions: Thromboendovenectomy is the procedure of choice for PVT. Results of liver transplantation in patients with PVT improve significantly with experience gained and are equivalent to results in patients without PVT.