Successful living donor liver transplantation with cavoportal hemitransposition in diffuse portomesenteric thrombosis.

Abstract

Diffuse porto-mesenteric thrombosis is considered to be a contraindication to living donor liver transplantation (LDLT) by numerous transplant centers. We report a successful case of LDLT with cavo-portal hemitransposition (CPHT) in a 36 year old male who presented with diffuse porto-mesenteric thrombosis and de-compensated end stage liver disease. Intraoperatively, the splenic artery was ligated to ameliorate portal hypertension and hypersplenism, and a LDLT with a right lobe graft was performed. In the presence of the porto-systemic collaterals, an end-to-end CPHT was fashioned, instead of a renoportal anastomosis, to provide portal inflow to the allograft. The graft to recipient body weight ratio was 1.06. The cold and warm ischaemia times were 119 and 64 minutes, respectively. Intraoperative Doppler ultrasonography of the allograft demonstrated good portal and arterial inflows with a normal venous outflow. Post-operatively, the patient had transient renal dysfunction that recovered gradually over a period of 19 days. He also had one episode of hematemesis due to persistent portal hypertension and required blood and platelet transfusions for pancytopenia due to hypersplenism. At follow-up after 26 months post-transplant, he is alive and well, his liver and renal functions tests are normal and CT angiography and Doppler ultrasonography showed a patent cavo-portal anastomosis with good flow. We have demonstrated that LDLT with CPHT can be performed safely in selected patients with diffuse port-mesenteric thrombosis.