Portal vein variation and thrombosis in right lobe living donor liver transplantation

Yıl 2019, Cilt: 3 Sayı: 1, 70 - 73, 27.01.2019

Gökhan Ertuğrul

https://doi.org/10.28982/josam.516815

Öz

Aim: The only definitive treatment of end stage liver disease is liver transplantation. In countries where cadaveric liver transplants are limited, living donor liver transplantation is performed. However, the presence of a variation in the portal vein of the donor, or a thrombus in the portal vein of the recipient, requires specific consideration. In this study, both of these potential limitations to living donor liver transplantation were evaluated.

Patients: We designed a retrospective cohort study. From April 2014 to December 2017 we retrospectively evaluated 129 patients who underwent right lobe living donor liver transplantation in Organ Transplantation Center, Medipol University Faculty of Medicine, Istanbul, Turkey.

Results: Nine (7%) of the patients underwent portal venous reconstruction due to either portal vein variation or portal vein thrombosis. In six patients (67%) reconstruction was performed due to the presence of a double PV in the right lobe graft. In three (33%) patients, a thrombus in the PV necessitated a reconstruction. Early postoperative morbidity occurred in one patient (11.1%) and mortality in one patient (11.1%).

Conclusions: In this study, we found portal vein reconstructions using safely frozen iliac vein grafts.

Anahtar Kelimeler

Right lobe living donor liver transplantation, Portal vein variation, Portal vein reconstruction, Portal vein thrombosis

Canlı vericili sağ lob karaciğer naklinde portal ven varyasyonları ve trombüsleri

Öz

Amaç: Son dönem karaciğer hastalığının kesin tek tedavi yöntemi karaciğer naklidir. Kadavra karaciğer naklinin sınırlı olduğu ülkelerde, canlı donör karaciğer nakli yapılır. Bununla birlikte, donörün portal veninde bir varyasyonun veya alıcının portal veninde bir trombüsün varlığı özel bir dikkat gerektirir. Bu çalışmada, canlı vericili karaciğer nakli için bu potansiyel sınırlamaların her ikisi de değerlendirildi.

Yöntemler: Retrospektif kohort çalışma planlandı. Nisan 2014 - Aralık 2017 tarihleri arasında Medipol Üniversitesi Tıp Fakültesi, Organ Nakli Merkezi'nde sağ lob canlı vericili karaciğer nakli yapılan 129 hastayı retrospektif olarak değerlendirdik.

Bulgular: Hastaların dokuzuna (%7) portal ven varyasyonu veya portal ven trombüsünden dolayı portal venöz rekonstrüksiyon uygulandı. Altı hastada (%67) sağ lob greftinde çift portal ven açıklığının olması nedeniyle rekonstrüksiyon yapıldı. Üç hastada (%33) portal vende trombüs nedeniyle rekonstrüksiyon yapıldı. Bir hastada (%11,1) ameliyat sonrası morbidite ve bir hastada (%11,1) mortalite görüldü.

Sonuç: Bu çalışmada, dondurulmuş iliak ven greftlerinin portal ven rekonstrüksiyonları için güvenli bir şekilde kullanılabileceği saptanmıştır.

Anahtar Kelimeler

Canlı vericili sağ lob karaciğer nakli, Portal ven varyasyonu, Portal ven trombüsü, Portal ven rekonstrüksiyonu

Kaynakça

• 1. Yamaoka Y, Washida M, Honda K, et al. Liver transplantation using a right lobe graft from a living related donor. Transplantation. 1994;57:1127–41.
• 2. Yerdel MA, Gunson B, Mirza D, et al. Portal Vein Thrombosis In Adults Undergoing Liver Transplantation: Risk Factors, Screening, Management, and Outcome. Clinical Transplantation. 2000;69(9):1873-81.
• 3. Cheng YF, Huang TL, Lee TY, et al. Variation of the intrahepatic portal vein; angiographic demonstration and application in living-related hepatic transplantation. Transplant Proc. 1996;28:1667.
• 4. Nonami T, Yokoyama I, Iwatsuki S, et al. The incidence of portal vein thrombosis at liver transplantation. Hepatology. 1992;16:1195-8.
• 5. Okuda K, Ohnishi K, Kimura K, et al. Incidence of portal vein thrombosis in livercirrhosis. An angiographicstudy in 708 patients. Gastroenterology. 1985;89:279–86.
• 6. Godeau B, Leroy-Matheron C, Gouault-Heilmann M, et al. A case of portal thrombosis associated with protein S deficiency. J Hepatol. 1993;18:258.
• 7. Orozco H, Takahashi T, Mercado MA, et al. Postoperative portal vein obstruction in patients with idiopathic portal hypertension. J Clin Gastroenterol. 1990;12:607.
• 8. Amitrano L, Brancaccio V, Guardascione MA, et al. Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis. Hepatology. 2000;31:345–8.
• 9. Shaw BW Jr, Iwatsuki S, Bron K, et al. Portal vein grafts in hepatic transplantation. Surg Gynecol Obstet. 1985;161:66–8.
• 10. Marcos A, Orloff M, Mieles L, et al. Reconstruction of double hepatic arterial and portal venous branches for right-lobe living donor liver transplantation. Liver Transpl. 2001;7:673.
• 11. Lee HJ, Hwang S, Ahn CS, et al. Long-Term Outcomes of Portal Y-Graft Interposition for Anomalous Right Portal Veins in Living Donor Liver Transplantation. Transplantation Proceedings. 2012;44:454–6.
• 12. Soyer P, Bluemke DA, Choti MA, et al. Variations in the intrahepatic portions of the hepatic and portal veins: Findings on helical CT during arterial portography. Am J Roentgenol1995;164:103-8.
• 13. Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variation: Prevalence with US. Radiology. 1992;184:157-8.
• 14. Kishi Y, Sugawara Y, Kaneko J, et al. Classification of portal vein anatomy for partial liver transplantation. Transplant Proc. 2004;36:3075-6.
• 15. Ikegami T, Soejima Y, Taketomi A, et al. Hilar anatomical variations in living donor liver transplantation using right-lobe grafts. Dig Surg. 2008;25:117-23.
• 16. Lerut J, Tzakis AG, Bron K, et al. Complications of orthotopic liver transplantation. Ann Surg. 1987;205:404–14.
• 17. Suzuki L, de Oliveira IR, Widman A, et al. Real-time and Doppler US after pediatric segmental liver transplantation: I. Portal vein stenosis. Pediatr Radiol. 2008;38:403.
• 18. Kanazawa H, Sakamoto S, Fukuda A, et al. Portal vein reconstruction in pediatric living donor liver transplantation for patients younger than 1 year with biliary atresia. Journal of Pediatric Surgery. 2012;47:523–7.
• 19. Moon JI, Jung GO, Choi GS, et al. Risk factors for portal vein complications after pediatric living donor liver transplantation with left-sided grafts. Transplant Proc. 2010;42:871-75.