Living donor liver transplantation for hepatitis C virus cirrhosis with a huge portal vein aneurysm

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Received November 25, 2007; accepted January 20, 2008.A57-year-oldfemalewasdiagnosedwithhepatocellularcarcinoma associated with hepatitis C virus–related cir-rhosis. She underwent ablation therapy several times,including 4 repeated courses of percutaneous ethanolinjection, and was finally referred to our hospital forliver transplantation. During the preoperative evalua-tion, a huge extrahepatic portal vein aneurysm (PVA)and mural thrombosis were detected on computed to-mographic angiography and magnetic resonance imag-ing angiography (Fig. 1). Massive ascites and a recana-lized umbilical vein were also noted. She underwentliving donor liver transplantation using her daughter’sright lobe graft. During surgery, the confluence of thesuperior mesenteric vein and splenic vein seemed to benormal and intact, so the whole PVA was resected, andthe mural thromboses were removed. Thereafter, directend-to-end anastomosis between the recipient portalvein and graft portal vein was successfully accom-plished without tension. The postoperative course wasuneventful until she developed portal vein thrombosisdue to anastomotic stenosis 1 year after the transplan-tation. The complication was successfully reversed bysystemic thrombolytic therapy using recombinant tis-sue plasminogen activator combined with subsequentpercutaneous transhepatic balloon dilatation. Sincethen, the patient has been doing well with normal liverfunction for the past 2 years.Abnormality of the portal vein is often observed inliver transplant candidates but mainly as stenosis orthrombosis in chronic diseases.