Preoperative portal vein recanalization–transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation
AffiliationDepartment of Surgery, Division of Transplant Surgery, University of Arizona
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PublisherJohn Wiley and Sons Inc
CitationTalwar, A., Varghese, J., Knight, G. M., Katariya, N., Caicedo, J.-C., Dietch, Z., Borja-Cacho, D., Ladner, D., Christopher, D., Baker, T., Abecassis, M., Mouli, S., Desai, K., Riaz, A., Thornburg, B., & Salem, R. (2022). Preoperative portal vein recanalization–transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation. Hepatology Communications.
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AbstractHigh-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. © 2022 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.
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Except where otherwise noted, this item's license is described as Copyright © 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License.
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- Authors: Salem R, Vouche M, Baker T, Herrero JI, Caicedo JC, Fryer J, Hickey R, Habib A, Abecassis M, Koller F, Vogelzang R, Desai K, Thornburg B, Hohlastos E, Resnick S, Lewandowski RJ, Sato K, Ryu RK, Ganger D, Kulik L
- Issue date: 2015 Nov
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- Authors: Thornburg B, Desai K, Hickey R, Hohlastos E, Kulik L, Ganger D, Baker T, Abecassis M, Caicedo JC, Ladner D, Fryer J, Riaz A, Lewandowski RJ, Salem R
- Issue date: 2017 Dec
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- Issue date: 2016 Mar
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- Authors: Habib A, Desai K, Hickey R, Thornburg B, Vouche M, Vogelzang RL, Salem R
- Issue date: 2015 Apr
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- Authors: Klinger C, Riecken B, Schmidt A, De Gottardi A, Meier B, Bosch J, Caca K
- Issue date: 2018 Mar