Title: Single Center Series of Liver Transplantation for Cirrhosis Complicated by Portal Vein Thrombosis or Stenosis
Abstract: Portal vein thrombosis (PVT) is a known complication of liver cirrhosis with reported incidence up to 32% and the rate of LT of only 1.2%-6.6% due to surgical complexity and risk. 691 liver transplants were performed in a period of 2008-2019. The rate of LT for PVT was 6.2% (43/691). The PV reconstruction (PVR) technique depended on PVT grade, age, presence of shunts and was composed of thrombectomy (19), reno-portal transposition (8), jump and interposition graft (2), mesoportal (1), shunt-to-portal anastomosis (2) in adults and cava-portal transposition (7), confluent-portal (2), venoplasty(2) in pediatric patients. The median age in PVR adults was compared to conventional PV anastomosis CPVA (p=0.08). Median blood loss, the rate of AKI, EAD and new onset PVT were 2000 [800; 3500] vs 1200 [700; 1700] (p = 0.06); 20% vs 15,7% (p = 0.7); 10% vs 24.5% (p = 0.3) and 10% vs 0,7% (0.07) in PVR compared to CPVA group. The median age in PVR pediatrics was compared to CPVA (p= 0,12). Median blood loss, the rate of AKI, EAD and new onset PVT were 150 [100; 250] vs 150 [100; 250] (p = 0.04); 9% vs 18,2% (p=0,9), 27.3% in PVR group vs 37,2% (p=1) and 10% vs 11.3% in CPVA (p =1) in PVR compared to CPVA group. PV reconstruction is a challenging procedure in LT for PVT and associated with higher rate of complications but not mortality. The choice of PV reconstruction/thrombectomy depend on PVT grade, age, and presence of suitable shunts.