Liver Transplantation Using Cavo-Portal Hemitransposition in Case of Complete Splanchnic Venous Thrombosis.
(2010) American Transplant Congress 2010, ATC 2010 — Location: San Diego (Ca), United States (1.May.2010)
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- (en) ntroduction: Portal vein (PV) thrombosis is no longer a contraindication to liver transplantation (LT) when adapted surgical techniques (e.g. thrombectomy, vascular interposition grafts, anastomosis to a PV collateral) can be used. In contrast, complete/ extensive venous splanchnic system thrombosis cannot be managed by these techniques and the short-term prognosis is very poor. Multi-visceral transplantation is a possible treatment option in these patients, but a technically/immunologically high-risk procedure. Cavo-portal hemi-transposition (CPHT) can be performed, establishing portal perfusion via recipient caval flow. Data on CPHT (<70 cases reported) and long-term outcome remain scarce. Aim: To analyse the results after LT with CPHT at 2 LT centers. Methods: CPHT was performed in 9 (0.57%) out of 1568 LT done between 02/1984- 09/2009 [4 females/5 males; median age 44 (32-71); 4 BuddChiari, 1 reTx/chronic rejection, 1 cryptogenic cirrhosis, 1 HCV cirrhosis, 1 hepatic failure, 1 FAP]. All had complete chronic (intraoperatively confirmed) splanchnic thrombosis associated to advanced liver failure and major portal hypertension. Recipient caval flow was completely diverted into the allograft PV using end-to-end (4/9) or end-to-side cavo-portal anastomosis (5/9).An interposition graft (iliac vein) was necessary in 3 patients. Results: Immediate graft function was adequate in all recipients. One patient developed PV thrombosis due to an anastomotic stricture treated by angioplasty. Surgical re-interventions were done for upper GI bleeding (splenectomy, n=2) and for arteriolar bleeding (n=1) at the biliodigestive anastomosis in the context of a late CPHT stenosis treated by angioplasty. Patient survival is 100% and 45% at 3 and 60 months, respectively. One patient died at 3 months due to biliary leak, one at 25 months due to recurrent HCC, one at 49 months due to intracranial bleeding, and 2 patients died at 2 and 14 months due to multiple organ failure. All 4 survivors display satisfactory liver/gut function at last follow-up (median:99 months; range:39-111). Conclusion: CPHT represents a valid salvage procedure providing excellent early-graft-function and acceptable 5-years survival (45%) in patients with diffuse splanchnic thrombosis not amenable to conventional LT. CPHT avoids a technically/ immunologically more challenging multi-visceral transplantation.
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Diethard, M., Bonaccorsi Riani, E., Darius, T., Ciccarelli, O., Aerts, R., Hassoun, Z., Laleman, W., Verslype, C., Nevens, J., & Pirenne, J. (2010). Liver Transplantation Using Cavo-Portal Hemitransposition in Case of Complete Splanchnic Venous Thrombosis. American Journal of Transplantation, 10(Suppl. 4), 256. https://hdl.handle.net/2078.5/218168 (Original work published 2010)