Risk factor analysis and diagnosis and treatment of early portal vein complications after liver transplantation

Abstract

Objective To explore the risk factors, diagnosis and treatment of early portal vein complications after liver transplantation. Methods From January 2016 to December 2018, clinical data of 616 adult patients undergoing liver transplantation were retrospectively analyzed. Nine cases (1.5%) had early portal vein complications. By comparing the general status of recipients and donors and the intraoperative findings, the risk factors of early portal vein complications were analyzed. Results No statistically significant differences existed in recipient age, gender, donor/recipient blood type, donor liver cold ischemia time, transplant operative duration, intraoperative non-hepatic period, intraoperative blood loss or intraoperative red blood cell transfusion (P>0.05). However, preoperative recipients had portal vein thrombosis, splenectomy, retransplantation and portal vein anastomosis. Statistical differences existed and all were risk factors for early portal vein complications (P<0.05). Binary logistic regression showed that preoperative patients had portal vein thrombosis [OR=16.922, 95% CI(1.859-154.059), P=0.012] and retransplantation [OR=64.871, 95% CI(8.293-507.435), P<0.001] was an independent risk factor for early portal vein complications. Nine cases of early portal vein complications were confirmed by ultrasound and/or computed tomography (CT) angiography. Three patients with portal vein thrombosis type 1 received oral medication while another three with portal vein thrombosis type 2 underwent abdominal portal vein incision, thrombectomy and large omental portal vein pump implantation. During a follow-up period of (22±14.8) months, portal vein blood flow remained patent. One patient with portal vein stenosis underwent portal vein balloon dilation and stent implantation. During a follow-up period of 17 months, portal vein blood flow remained patent. Two patients with abnormal portal vein blood flow underwent liver re-transplantation and died postoperatively. Conclusions Preoperative portal vein thrombosis and splenectomy, re-transplantation of liver and end-to-end anastomosis of non-donor recipient portal vein are risk factors for early portal vein complications after liver transplantation. Individualized treatments of portal vein thrombosis may be provided according to the type of thrombus and liver function. And the prognosis is decent. Because of a higher mortality rate, attention should be paid to patients with abnormal portal vein blood flow immediately after re-transplantation. Key words: Liver transplantation; Portal complications; Risk factors; Diagnosis; Treatment; Prognosis