Outcomes of living donor liver transplantation for patients with preoperative portal vein problems

Abstract

Introduction: Portal vein thrombosis (PVT) is a common complication for patients with end-stage liver disease. The presence of PVT used to be a contraindication to LDLT. This is related to technical difficulties of PV reconstruction, increased blood loss, and the risk for postoperative PV complications. Methods: We reviewed the data of LDLT patients at Liver Transplantation Unit, Mansoura University, Egypt during the period between May 2004 till March 2017. Patients were divided into three groups. Group I: patients without PVT, Group II: attenuated PV patients (PV diameter <8 mm), and Group III PVT patients. Results: During the study period, 500 cases underwent LDLT. Group I included 446 patients (89.2%), Group II included 26 patients (5.2%), and Group III included 28 patients (5.6%). Higher incidence of hematemesis and encephalopathy was detected in Group III. Longer anhepatic phase duration was found in Group III. There were no significant differences regarding operation time, blood loss, and transfusion requirements. Higher incidence of postoperative vascular complications was found in Group III. The median OS was 33 months (4-169). The 1-, 3-, and 5-years OS survival rates of Group I were 80.5%, 77.7%, and 75%, while for Group II were 84.6%, 79.6%, and 73.5%, and for Group III were 88.3%, 64.4%, and 64.4% respectively. There was no significant difference between the groups regarding OS rates (Log-Rank: 0.793). Conclusion: Preoperative PVT increases the complexity of LDLT operation and the operative trauma to the patient, but it does not reduce the OS rates.