Postoperative Portal Vein Thrombosis Research Articles

Initial Experience with Single Port Robotic Right Colectomies: Results of an Investigator-Initiated Investigational Device Exemption Study Using a Novel Single Port Robotic Platform

BACKGROUND: Minimally invasive surgical techniques have been widely adopted in colorectal surgery. New technological breakthroughs have led to even less invasive alternatives like single-port surgery, but this has been hindered by technical challenges such as collision of the robotic arms within a limited space. The Intuitive da Vinci single port robotic platform is a novel system that overcomes some of these challenges. IMPACT OF INNOVATION: The aim of this study was to assess the safety and feasibility of the Intuitive da Vinci Single Port robotic platform in right segmental colectomies among adult patients. These findings may set the stage for more widespread use of single port robotic surgery. TECHNOLOGY MATERIALS AND METHODS: The Intuitive da Vinci Single-Port SP robot is a system designed specifically for single port robotic surgery. This platform enables flexible port location and efficient internal and external range of motion by utilizing a single C-shaped arm. In our study, right colectomies were performed in adult patients using this platform between May 2022 and November 2022 and compared to right colectomies in adult patients done using the standard multiport platform between Jan 2019- December 2022. The main outcome measure was safety and quality event rate. PRELIMINARY RESULTS: Among 5 patients who underwent single port robotic right colectomy, and 83.3% (n=25) underwent multiport right colectomy. In the single port group, 40% (n = 2) developed a safety/quality event (postoperative portal vein thrombosis and excessive postoperative pain). Of the multiport group, 32% (n = 8) had one safety/quality event, and 8% (n = 2) had more than one event. CONCLUSIONS AND FUTURE DIRECTIONS: This preliminary study, one of the first FDA-approved, investigator-initiated uses of this platform in colorectal surgeries, shows that this platform is a safe and feasible option for right colectomies and on preliminary evaluation appears comparable in terms of relevant safety/quality events to the multiport platform. Trial Registration: Clinicaltrials.gov NCT05321134 Trial Funding: American Society of Colon & Rectal Surgeons (ASCRS) Research Foundation.

Predictors of portal vein thrombosis after splenectomy in patients with cirrhosis.

Portal vein thrombosis (PVT) is a commonthsn complication after splenectomy in patients with cirrhosis. However, the predictors of postoperative PVT are not known. To investigate the predictors of PVT after splenectomy in patient with cirrhosis. A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018. The incidence of PVT at 1 months, 3 months, and 12 months after splenectomy in patients with cirrhosis was observed. The hematological indicators, biochemical and coagulation parameters, and imaging features were recorded at baseline and at each observation point. The univariable, multivariable, receiver operating characteristic curve and time-dependent curve analyses were performed. The cumulative incidence of PVT was 40.0%, 46.6%, and 48.9% at 1 months, 3 months, and 12 months after splenectomy. Multivariable analysis showed that portal vein diameter (PVD) ≥ 14.5 mm and monthsdel‎ end-stage liver disease (MELD) score > 10 were independent predictors of PVT at 1 months, 3 months, and 12 months after splenectomy (P < 0.05). Time-dependent curve showed that the cumulative incidence of PVT was significantly different between patients with MELD score ≤ 10 and > 10 (P < 0.05). In addition, the cumulative incidence of PVT in the PVD ≥ 14.5 mm group was significantly higher than that in the PVD < 14.5 mm group (P < 0.05). Wider PVD and MELD score > 10 were independent predictors of PVT at 1 months, 3 months, and 12 months after splenectomy in patient with cirrhosis.

Early portal vein thrombosis after hepatectomy for perihilar cholangiocarcinoma: Incidence, risk factors, and management

To study the incidence, risk factors and management of portal vein thrombosis (PVT) after hepatectomy for perihilar cholangiocarcinoma (PHCC). Single-center retrospective analysis of 86 consecutive patients who underwent major hepatectomy for PHCC, between 2012 and 2019, with comparison of the characteristics of the groups with (PVT+) and without (PVT-) postoperative portal vein thrombosis. Seven patients (8%) presented with PVT diagnosed during the first postoperative week. Preoperative portal embolization had been performed in 71% of patients in the PVT+ group versus 34% in the PVT- group (P=0.1). Portal reconstruction was performed in 100% and 38% of PVT+ and PVT- patients, respectively (P=0.002). In view of the gravity of the clinical and/or biochemical picture, five (71%) patients underwent urgent re-operation with portal thrombectomy, one of whom died early (hemorrhagic shock after surgical treatment of PVT). Two patients had exclusively medical treatment. Complete recanalization of the portal vein was achieved in the short and medium term in the six survivors. After a mean follow-up of 21 months, there was no statistically significant difference in overall survival between the two groups. Post-hepatectomy PVT for PHCC is a not-infrequent and potentially lethal event. Rapid management, adapted to the extension of the thrombus and the severity of the thrombosis (hepatic function, signs of portal hypertension) makes it possible to limit the impact on postoperative mortality. We did not identify any modifiable risk factor. However, when it is oncologically and anatomically feasible, left±extended hepatectomy (without portal embolization) may be less risky than extended right hepatectomy, and portal vein resection should only be performed if there is strong suspicion of tumor invasion.

A Single-Center's Early Surgical Outcomes of Living Donor Liver Transplantation

Living donor liver transplantation (LDLT) has become an increasingly common surgical option because the number of cadaveric donors is insufficient to fulfill the organ needs of patients facing end-stage cirrhosis. Many centers are investigating different surgical techniques to achieve lower complication rates. We aimed to examine our complication rates in light of demographic data, graft data, and perioperative findings as a single-center experience. The study included one hundred and three patients who underwent LDLT for end-stage liver cirrhosis. Demographic data; sex; age; blood group; Model for End-Stage Liver Disease score; Child score; etiology; liver side; graft-to-recipient weight ratio; hepatic artery, portal vein, and bile anastomosis type rates; anhepatic phase; cold ischemia time; operation time; and blood product transfusion rates were analyzed. Biliary complications in patients with single or multiple biliary anastomoses, right or left liver transplants, and with or without hepatic artery thrombosis were analyzed statistically. There was no significant difference in biliary complications between patients who underwent single or multiple bile anastomosis (P=.231) or patients receiving right lobe and left lobe transplants (P=.315). Although there was no statistically significant difference in the rate of portal vein thrombosis between the regular and reconstructed portal vein anastomosis groups (P=.693), the postoperative portal vein thrombosis rate was statistically higher in patients with left lobe transplants (P=.044). Vascular and biliary complication rates can be reduced with increasing experience.

Management of post-operative portal vein thrombosis after pancreatectomy: A systematic review

Background: Post-operative portal vein thrombosis (PPVT) is a potentially fatal complication following pancreatectomy and can occur in 1.2-5% [1] of patients after resection. Treatment strategies include therapeutic anticoagulation (TAC), portal vein stent (PVS), or thrombectomy. To date, there has been no consensus on the optimal treatment strategy. The objective of this study is to systematically review the incidence and management of PPVT following pancreatectomy and to compare the clinical outcomes of treatment.

Risk factors for postoperative portal vein thrombosis in patients with hepatitis B liver cancer and its impact on mortality-a retrospective study.

BackgroundThe treatment of portal thrombosis is very difficult, which can seriously affect the prognosis of the patients, and thus, preventing postoperative portal thrombosis in patients with hepatitis B liver cancer is crucial. Identifying the risk factors in these patients is key to preventing postoperative portal vein thrombosis. However, relevant research is currently lacking. The present study was to study the risk factors for postoperative portal vein thrombosis in patients with hepatitis B liver cancer and its impact on mortality.MethodsWe retrospectively included 663 patients with hepatitis B liver cancer admitted to the Second Affiliated Hospital of Anhui Medical University and Shenzhen University General Hospital from January 2017 to December 2021. The patients were divided into a portal thrombosis group (n=54) and a control group (n=609) according to whether they had portal thrombosis after surgery. The clinical characteristics including alcoholism, D-dimer, surgery method and tumor diameter of the two groups were compared, and the treatment and mortality of the patients in the portal thrombosis group were analyzed.ResultsThe incidence of portal vein thrombosis in patients with hepatitis B liver cancer was 8.14% (54/663). The area under the Receiver operator characteristics curve for the diagnostic value of D-dimer for postoperative portal vein thrombosis in patients with hepatitis B liver cancer was 0.716 (95% CI: 0.650–0.781, P=0.000). Alcoholism, D-dimer >8.74 mg/L, open surgery, and a maximum tumor diameter >5 cm were identified as risk factors for portal vein thrombosis after surgery in patients with hepatitis B hepatitis cancer [odds ratio: 2.991 (95% CI: 1.234–7.249), P=0.015; odds ratio: 3.269 (95% CI: 1.683–6.349), P=0.000; odds ratio: 6.726 (95% CI: 3.419–13.232), P=0.000; odds ratio: 2.443 (95% CI: 1.344–4.442), P=0.003]. Patients with Grade I or II grade Yerdel (96.30%) were cured after treatment, while two patients with III grade (3.70%) died after surgery.ConclusionsThe incidence of portal vein thrombosis after surgery in patients with hepatitis B liver cancer is high. Intervention against risk factors may be beneficial to improve the prognosis of patients with hepatitis B liver cancer.

Portal Vein Resection in Pancreatic Cancer Surgery: Risk of Thrombosis and Radicality Determine Survival.

To evaluate the outcomes of pancreatic cancer [pancreatic ductal adenocarcinoma (PDAC)] surgery with concomitant portal vein resection (PVR), focusing on the PVR type according to the International Study Group of Pancreatic Surgery (ISGPS). Surgery offers the only chance for cure in PDAC. PVR is often performed for borderline or locally advanced tumors. Consecutive patients with PDAC operated between January 2006 and January 2018 were included. Clinicopathologic characteristics and outcomes were analyzed and tested for survival prediction. Of 2265 PDAC resections, 1571 (69.4%) were standard resections and 694 (30.6%) were resections with PVR, including 149 (21.5%) tangential resections with venorrhaphy (ISGPS type 1), 21 (3.0%) resections with patch reconstruction (type 2), 491 (70.7%) end-to-end anastomoses (type 3), and 33 (4.8%) resections with graft interposition (type 4). The 90-day mortality rate was 2.6% after standard resection and 6.3% after resection with PVR ( P <0.0001). Postoperative portal vein thrombosis and pancreas-specific surgical complications most frequently occurred after PVR with graft interposition (21.2% and 48.5%, respectively). In multivariable analysis, age 70 years and above, ASA stages 3/4, increased preoperative serum carbohydrate antigen 19-9, neoadjuvant treatment, total pancreatectomy, PVR, higher UICC stage, and R+ resections were significant negative prognostic factors for overall survival. Radical R0 (>1mm) resection resulted in 23.3 months of median survival. This is the largest single-center, comparative cohort study of PVR in PDAC surgery, showing that postoperative morbidity correlates with the reconstruction type. When radical resection is achieved, thrombosis risk is outweighed by beneficial overall survival times of nearly 2 years.

Portal vein thrombosis after right hepatectomy: impact of portal vein resection and morphological changes of the portal vein.

Right hepatectomy occasionally requires portal vein resection (PVR) and causes postoperative portal vein thrombosis (PVT). A total of 247 patients who underwent right hepatectomy were evaluated using a three-dimensional analyzer to identify the morphologic changes in the portal vein (PV). The patients' characteristics were compared between the PVR group (n = 73) and non-PVR group (n = 174), and risk factors for PVT were investigated. The PVR group were subdivided into the wedge resection (WR) group (n = 38) and segmental resection (SR) group (n= 35). Postoperative PVT occurred in 20 patients (8.1%). Multivariate analyses in all patients revealed that postoperative left PV diameter/main PV diameter (L/M ratio) <0.56 (odds ratio [OR] 4.00, p = 0.009) and PVR (OR 3.31, p = 0.031) were significant risk factors for PVT. In 73 patients who underwent PVR, PVT occurred in 14 (19%) and WR (OR 11.5, p = 0.005) and L/M ratio <0.56 (OR 5.51, p = 0.016) were significant risk factors for PVT. PVR was one of the significant risk factors for PVT after right hepatectomy. SR rather than WR may be recommended for preventing PVT.

Chinese expert surgical procedure consensus on open pericardial devascularization(2021)

Although the treatment strategy of esophageal and gastric varices bleeding in portal hypertension has been diversified and multidisciplinary now,the surgical treatment represented by pericardial devascularization operation will still play an important and irreplaceable role in China. In order to standardize the surgical procedure,guide clinical practice and improve the level of surgical treatment of portal hypertension,Chinese Society of Spleen and Portal Hypertension Surgery,Chinese Surgical Society,Chinese Medical Association organized Chinese experts to formulate this consensus. The main contents include:the position of surgical treatment,surgical indications and contraindications,preoperative evaluation,key points and precautions of surgical procedure,perioperative treatment,prevention and treatment of postoperative complications. The consensus emphasizes the standardization of surgical treatment of portal hypertension,pay attention to the prevention and treatment of postoperative portal vein thrombosis,and expect to provide surgeons with clinical guidance.

A Case of Acute Pancreatitis Due to Compression of Postoperative Portal Vein Thrombosis That Originated from a Portal Vein Aneurysm

A Case of Acute Pancreatitis Due to Compression of Postoperative Portal Vein Thrombosis That Originated from a Portal Vein Aneurysm

Portal Vein Thrombosis after Major Liver Resection for Cholangiocarcinoma and Gallbladder Cancer

Introduction: The incidence of and risk factors for postoperative portal vein thrombosis after major liver resection with resection of extrahepatic bile ducts for gallbladder cancer and intrahepatic cholangiocarcinoma with hilar extension, and perihilar cholangiocarcinoma have not been fully elucidated. Method: In this retrospective cohort study, we analysed the influence of clinical, procedural and pathological factors with respect to the incidence of postoperative portal vein thrombosis. Results: A total of 99 patients were included, of whom 9 patients developed portal vein thrombosis diagnosed 6 (1-18) days after operation. Treatment consisted of thrombectomy and anticoagulation only in 3 and 6 patients, respectively. In patients receiving anticoagulation only, the portal thrombosis was partial in 3 patients. Recanalisation was achieved in all patients. No specific factor was found predictive of portal vein thrombosis, including age (p=0.188), type of cancer (p=0.126), type of liver resection (p=0.871), caudate lobe resection (p=0.493) or portal vein resection (p=0.235). Conclusions: Portal vein thrombosis is a common complication after major liver resection for biliary cancers. Anticoagulation or reoperation with thrombectomy are both effective treatments.

Pancreaticoduodenectomy with Complex Vascular Reconstruction Is Safe and Oncologically Justified

Introduction: The aim of this study was to analyze the experience in two transplant centers of patients undergoing pancreaticoduodenectomy (PD) with or without vascular reconstruction. Method: We retrospectively reviewed prospectively collected data of all consecutive patients undergoing pancreaticoduodenectomy (PD) for cancer, between 1/1/2013 and 1/31/2018. The overall cohort (n=197) was divided into those with vascular reconstruction (Group1, n=38) and without vascular reconstruction (Group2, n=159). Results: The two groups were similar in terms of age, sex distribution, and pre-operative ASA score. One post-operative portal vein thrombosis was seen in each group (NS). Peri-operative mortality occurred in one patient in Group 2 due to post-op bleeding. Hospital length of stay (8d vs 7d, p=0.14), ICU length of stay (2d vs 1d, p=0.47), and blood loss (350cc vs 300cc) were similar in both groups. The length of surgery was longer in Group 1 (438 minutes vs 341, p<0.0001). Both groups had similar rates of Clavien grade 3 or higher morbidity (15.8% in Group1 and 15.7% in Group2, p=0.83). R0 resection rate was lower in Group 1 (73.7% vs 92.5%, p=0.001). However, the local recurrence rates did not differ between the two groups - 17 (44.7%) in Group 1 and 71 in Group 2 (44.7%, p=0.992). Kaplan-Meier analysis showed no difference in overall and disease-free survival, and also when limiting the pathology to only pancreatic ductal adenocarcinoma. Conclusions: Our experience shows that complex vascular reconstruction in PD can be achieved safely when done by experienced teams, and with comparable cancer outcomes in selected patients.

Long term outcomes and complications of reno-portal anastomosis in liver transplantation: results from a propensity score-based outcome analysis.

Diffuse splanchnic vein thrombosis (DSVT) remains a serious challenge in liver transplantation (LT). Reno-portal anastomosis (RPA) has previously been reported as a valid option for management of patients with DSVT during LT. The aim of this study was to evaluate post-transplant renal function and surgical outcomes of patients with DSVT who underwent RPA during LT. Between January 2005 and December 2017, 1270 patients underwent LT at our institution, including 16 with DSVT managed with RPA (RPA group). We compared renal function and surgical outcomes in these patients to outcomes in 48 propensity score (PS)-matched patients without thrombosis (control group), using a 1:3 matching model. The two groups had similar rates of postoperative portal vein thrombosis (PVT), renal dysfunction as measured by estimated glomerular filtration rate (eGFR), and overall postoperative complications (Clavien grade III), although the RPA group had a higher incidence of postoperative upper gastrointestinal (GI) bleeding (31.3% vs 4.2%; P=0.009) that had no clinical consequence. There were no significant differences in five-year graft and patient survival rates between the groups (P=0.133 and P=0.166, respectively). RPA is an established technique in the management of patients with DSVT during LT, with comparable outcomes to patients without thrombosis. Our report is the first to demonstrate similar surgical outcomes, including long-term renal function, in LT recipients with or without RPA.

Low level of postoperative plasma antithrombin III is associated with portal vein thrombosis after liver surgery.

Although decreased antithrombin-III (AT-III) is a risk factor for portal vein thrombosis (PVT) in patients with liver cirrhosis, the association between postoperative PVT and postoperative AT-III levels is unknown in patients undergoing hepatectomy. Patients who underwent hepatectomy between 2015 and 2018 were retrospectively analyzed. Postoperative PVT was assessed on CT at days 6-9 after hepatectomy. One-to-one propensity score (PS) matching was used to match the baseline characteristics. Of the 295 patients included in this analysis, 19 patients (6.4%) were diagnosed with postoperative PVT. The AT-III level on postoperative day (POD) 3 predicted postoperative PVT with a sensitivity/specificity of 74%/59% (AUC, 0.644; cut-off value, 60%; p = 0.032). Multivariate analysis revealed that AT-III levels ≤ 60% on POD3 (OR, 3.01; 95% CI 1.02-8.89; p = 0.046), cirrhosis (OR, 5.88; 95% CI 1.92-18.0; p = 0.002) and right-sided hepatectomy (OR, 4.16; 95% CI 1.45-11.9; p = 0.0079) were significant risk factors for postoperative PVT. After PS matching, 56 patients with and without AT-III supplementation were analyzed. The two groups had a similar incidence of PVT (p = 0.489). Patients with AT-III levels ≤ 60% on POD3 should be carefully followed up regarding postoperative PVT. Our results did not support the efficacy of routine AT-III supplementation for the prophylaxis of postoperative PVT.

Prediction of portal vein thrombosis after hepatectomy for hepatocellular carcinoma.

Portal vein thrombosis (PVT) following hepatectomy is potentially life-threatening. We aimed to evaluate the incidence of PVT after hepatectomy for hepatocellular carcinoma and identify coagulation and fibrinolytic factors that could predict early-stage postoperative PVT. A retrospective analysis was conducted on 65 hepatocellular carcinoma patients who underwent radical hepatectomy. The risk factors for postoperative PVT were identified based on univariate and multivariate analyses, and the levels of coagulation and fibrinolytic factors were measured during the perioperative period. The incidence of PVT after hepatectomy was 20.0%. The patients were divided into two groups: those with PVT (n=13; PVT group) and those without PVT (n=52; no-PVT group). The frequency of the use of the Pringle maneuver during surgery was higher in the PVT group than in the no-PVT group, and the postoperative/preoperative ratios of thrombin-antithrombin III complex (TAT) and of D-dimer were significantly higher in the PVT group. A high incidence of PVT was found in hepatocellular carcinoma patients after hepatectomy. The frequency of the Pringle maneuver is a potential risk factor for postoperative PVT, and the postoperative/preoperative TAT and D-dimer ratios may be used as early predictors of PVT after hepatectomy for hepatocellular carcinoma.

Narrowing of the remnant portal vein diameter and decreased portal vein angle are risk factors for portal vein thrombosis after perihilar cholangiocarcinoma surgery.

To evaluate the incidence, risk factors, management options, and outcomes of portal vein thrombosis following major hepatectomy for perihilar cholangiocarcinoma. A total of 177 perihilar cholangiocarcinoma patients who (1) underwent major hepatectomy and (2) underwent investigating the portal vein morphology, which was measured by rotating the reconstructed three-dimensional images after facilitating bone removal using Aquarius iNtuition workstation between 2002 and 2018, were included. Risk factors were evaluated using the Kaplan-Meier method and Cox proportional hazard models. Six patients developed portal vein thrombosis (3.4%) within a median time of 6.5 (range 0-22) days. Portal vein and hepatic artery resection were performed in 30% and 6% patients, respectively. A significant difference in the probability of the occurrence of portal vein thrombosis (PV) within 30 days was found among patients with portal vein resection, a postoperative portal vein angle < 100°, remnant portal vein diameter < 5.77 mm, main portal vein diameter > 13.4 mm, and blood loss (log-rank test, p = 0.003, p = 0.06, p < 0.0001, p = 0.01, and p = 0.03, respectively). Decreasing the portal vein angle and narrowing of the remnant PV diameter remained significant predictors on multivariate analysis (p = 0.027 and 0.002, respectively). Reoperation with thrombectomy was performed in four patients, and the other two patients were successfully treated with anticoagulants. All six patients subsequently recovered and were discharged between 25 and 70 days postoperatively. Narrowing of the remnant portal vein diameter and a decreased portal vein angle after major hepatectomy for perihilar cholangiocarcinoma are significant independent risk factors for postoperative portal vein thrombosis.

Low Level of Postoperative Plasma Antithrombin III Is Associated with Portal Vein Thrombosis after Liver Surgery

Background: Decreased antithrombin-III (AT-III) is a risk factor of portal vein thrombosis (PVT) in patients with liver cirrhosis. The association between PVT and postoperative AT-III is controversial in patients who underwent liver surgery. The efficacy of postoperative AT-III supplementation on PVT is also uncertain. Methods: Patients who underwent hepatectomy for hepato-biliary disease between 2015-2018 were retrospectively analyzed. Donors and recipients for liver transplantation were excluded. Postoperative PVT was assessed on computed tomography on the day 6-9 after hepatectomy. Results: Of the 325 patients included in this analysis, 19 patients (5.8%) were diagnosed as postoperative PVT. AT-III level on postoperative day (POD) 3 predicted postoperative PVT with a sensitivity/specificity of 74%/59% (area under the curve, 0.644; cut-off value, 60%; p=0.032). Univariate analysis revealed that AT-III level ≤60% on POD3 was the only significant risk factor for postoperative PVT (Table). Postoperative AT-III supplementation was not associated with reduced incidence of PVT. Although postoperative AT-III supplementation and major hepatectomy were the significant risk factors for postoperative hemorrhagic complications in univariate analysis, multivariate analysis revealed that major hepatectomy was the only significant risk factor for hemorrhagic complications. Conclusion: Patients with AT-III level ≤60% on POD3 should be given careful attention to postoperative PVT. Although postoperative supplementation of AT-III is safe without increased risk of hemorrhagic complication, the efficacy of it on PVT is still controversial.

Dextranum in Combination with Low-Molecular-Weight Heparin Prevents the Portal Vein Thrombosis after Splenectomy for Portal Hypertension

This study aimed to explore the effect of dextranum in combination with low-molecular-weight heparin on the prevention of portal vein thrombosis after splenectomy for portal hypertension. Between February 2015 and February 2019, we enrolled 128 liver cirrhosis patients with portal hypertension as the subjects which were later divided randomly into the observation group and the control group, with 64 patients in each group. All patients received the splenectomy in combination with the esophagogastric devascularization. Following the surgery, dextranum was given to the patients in two groups for prevention of portal vein thrombosis, while those in the observation would additionally took low-molecular-weight heparin for prophylaxis of portal vein thrombosis. After medication, incidence of portal vein thrombosis after surgery was recorded, and at 1 d and 14 d after surgery, the platelet count in peripheral blood was also detected; furthermore, we recorded the condition of patients in preventive anti-coagulation treatment, oral administration of enteric-coated aspirin, postoperative hospitalization days and the incidence of complications, including gastrointestinal bleeding and liver failure, within 3 mo after operation. In the observation group, the incidence rate of postoperative portal vein thrombosis was 9.37 %, significantly lower than 31.25 % in the control group (p<0.05), while the difference in the platelet count test at 1 d after operation showed no statistical significance (p>0.05), and the platelet count test showed an increasing trend at 14 d after operation (p<0.05); however, the intergroup comparison showed no significant difference (p>0.05). Between two groups, the duration of preventive anti-coagulation treatment and oral administration of aspirin showed no significant difference (p>0.05), while the patients had a shorter hospitalization duration in the observation group than their counterparts in the control group (p<0.05). Within 3 mo after operation, the incidence rate of complications, including gastrointestinal bleeding and liver failure, in the observation group was 6.25 %, significantly lower than 26.56 % in the control group (p<0.05). After splenectomy for portal hypertension, dextranum in combination with the low-molecularweight heparin can prevent the portal vein thrombosis by inhibiting the platelet aggregation, thereby promoting the patients’ recovery and decreasing the incidence of postoperative complications.

The Impact of Portal Vein Thrombosis on Liver Transplant Outcomes: Does Grade or Flow Rate Matter?

Portal vein thrombosis (PVT) makes the technical aspect of liver transplantation challenging and also affects outcomes. Our aim was to study impact of PVT grade and postreperfusion portal flow on posttransplant outcomes. Patients who underwent transplantation with PVT between January 2007 and May 2017 were selected (n = 126). Data on grade of PVT and portal vein flow were collected. Patients were classified into 2 groups; low grade (Yerdel Grade I, n = 73) and high grade (Yerdel Grade II or III, n = 53). Using portal flow rate, patients were divided into high flow (≥1000 mL/min, n = 95) and low flow (<1000 mL/min, n = 31). Additional analyses of flow by graft weight and complications were performed. Postoperatively, incidence of biliary strictures were significantly greater in high-grade PVT compared with low grade (P = 0.02). Incidence of postoperative portal vein thrombosis was higher in low flow after reperfusion compared with high flow (P = 0.02), as was bile leak (P = 0.02). On identifying factors associated with graft loss, moderate to severe ascites preoperatively, high PVT grade and bile leak were associated with worse graft survival. Subanalysis performed combining grade and flow showed that low grade, high flow had the highest graft survival while high grade, low flow had the lowest (P = 0.006). High-grade PVT with low flow also appeared to be an independent risk factor for biliary complications (P = 0.01). In conclusion, biliary complications, especially strictures are more common in high-grade PVT and graft survival is worse in high-grade PVT and low portal flow.

Portal Vein Thrombosis After Total Pancreatectomy and Islet Autotransplant: Prophylaxis and Graft Impact.

To determine the rate of portal vein thrombosis (PVT) based on pharmacologic prophylaxis protocol and the impact of PVT on islet graft function after total pancreatectomy with islet autotransplantation (TPIAT). We compared the incidence of PVT, postsurgical bleeding, and thrombotic complications in patients undergoing TPIAT between 2001 and 2018 at the University of Minnesota who received either unfractionated heparin (UFH) or enoxaparin for postoperative PVT prophylaxis. Six-month and 1-year graft function was compared between patients who developed PVT and those who did not. Twelve patients (6.6%) developed a PVT, which resolved by 6 months after TPIAT in 10 patients. There was no statistically significant difference in PVT rate between patients who received UFH or enoxaparin for prophylaxis (P = 0.54). Patients who received enoxaparin developed other thrombotic complications more often (6% vs 0%, P = 0.02). Islet graft function did not differ in patients who developed PVT versus those who did not. There was no difference between enoxaparin or UFH prophylaxis in preventing PVT, but there may be a higher incidence of other thrombotic complications with enoxaparin. In the setting of routine screening and anticoagulation therapy, PVT is a self-limited process.