Cavoportal hemitransposition in liver transplant recipients with complete and diffuse splanchnic venous thrombosis
(2012) 24th International Congress of the Transplantation Society — Location: Berlin, Germany (15.July.2012)
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- (en) Aim: In 1998, Tzakis first described cavoportal hemitransposition (CPHT) as a treatment option in liver transplant (LT) recipients with diffuse/ complete splanchnic thrombosis. Aim of this study was to review the outcome of CPHT in LT. Material and methods: Between 1-1-2001 and 30-11-2011, 8 CPHT were performed in 2 Belgian centers. Indications for LT were Budd-Chiari syndrome (n=4; 1 with associated hepatocellular carcinoma), cryptogenic cirrhosis (n=1), re-LT because of chronic rejection (n=1), HCV-cirrhosis (n=1) and secondary biliary cirrhosis (n=1). No patient underwent splenectomy before LT. Median recipient age was 46 years (range, 41 -71). Median follow-up was 38 months (range, 2 - 139). Results: Decision to perform a CPHT was taken before LT in 6 patients and intraoperatively in 2. Piggyback reconstruction was performed in 3 recipients, while in 5 recipients a classical caval reconstruction was performed with the use of veno-venous bypass. CPHT was achieved via an end-to-side cavoportal anastomosis in 6 cases and via an end-to-end anastomosis in 2 cases. An interposition donor venous iliac graft was necessary in 6. CPHT was total with complete derivation of infrahepatic caval blood flow into the liver graft. One and 5-year patient survival was 75% and 38%, respectively. One patient underwent splenectomy and gastric devascularisation 1 year after LT because of repetitive gastrointestinal bleedings. This patient also underwent a radiological intervention for resolving a stenosis at the level of the cavoportal anastomosis. Morbidity after LT consisted of prolonged ascites (n=7), renal dysfunction (n=6; 2 needed temporarily hemodialysis), recurrent gastrointestinal bleeding (n=3), thrombosis of the graft portal vein (n=3) and thrombosis of the inferior vena cava (n=1). The main cause of early mortality was bacterial infection, respectively 2 (peritonitis) and 4 months (pneumonia) after LT. The causes of late mortality were late hepatic artery thrombosis, cerebral vascular accident and recurrence of hepatocellular carcinoma, respectively 15, 26 and 50 months after LT. Conclusions: Diffuse/complete splanchnic thrombosis is no longer an absolute contraindication for isolated LT. In these patients, CPHT is a surgically feasible option and an alternative to a more radical multivisceral transplantation. Morbidity and mortality rates which remain however important, can probably be lowered by refining the allograft implantation technique and patient selection.
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Lai, Q., Darius, T., Monbaliu, D., Pinheiro, R., Ciccarelli, O., Pirenne, J., & Lerut, J. (2012). Cavoportal hemitransposition in liver transplant recipients with complete and diffuse splanchnic venous thrombosis. Transplantation, 94(10S), 168. https://hdl.handle.net/2078.5/31212 (Original work published 2012)