Liver transplantation for cirrhosis complicated by non-tumor thrombosis of mesenteric portal system

Abstract

Aim. To develop a universal technology of thrombectomy from the veins of the mesenteric portal system and to evaluate the outcomes of liver transplantation for cirrhosis combined with non-tumorous portal vein thrombosis.Materials and methods. Immediate and long-term results of 309 transplantations in patients with liver cirrhosis of various etiologies were studied. In 46 cases (14.9%), transplantation was performed in patients with liver cirrhosis and concomitant thrombosis in the veins of the mesenteric portal system. Results. A versatile method of thrombectomy, depending on the degree of thrombosis in the veins of the mesenteric portal system was proposed (M.A. Yerdel et al., 2000). Mesenteric portal vein thrombosis increased duration of transplantation and volume of intraoperative blood loss as compared to patients without concomitant thrombosis. No statistically significant differences were found in the overall incidence of postoperative complications, hospital mortality and duration of hospitalization of the patients after liver transplantation with concomitant venous thrombosis compared to the patients without thrombosis. The incidence of thrombotic complications, including hepatic artery thrombosis, was significantly higher after liver transplantation supplemented with thrombectomy from the portal vein system. Five-year survival rate of the patients after liver transplantation with concomitant thrombosis in the veins of the mesenteric portal system was 94.9% (median – 40 months), patients without thrombosis in the veins of the mesenteric portal system – 93.2% (median – 60 months).Conclusion. Transplantation in patients with cirrhosis and thrombosis in the veins of the mesenteric-portal system shows good immediate and long-term results in case proper thrombectomy is carried out.