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 Detalle_Publicacion

Alternative forms of portal vein revascularization in liver transplant recipients with complex portal vein thrombosis

Abstract: Background & Aims Complex portal vein thrombosis (PVT) is a challenge in liver transplantation (LT). Extra-anatomical approaches to portal revascularization, including renoportal (RPA), left gastric vein (LGA), pericholedochal vein (PCA), and cavoportal (CPA) anastomoses, have been described in case reports and series. The RP4LT Collaborative was created to record cases of alternative portal revascularization performed for complex PVT. Methods An international, observational web registry was launched in 2020. Cases of complex PVT undergoing first LT performed with RPA, LGA, PCA, or CPA were recorded and updated through 12/2021. Results A total of 140 cases were available for analysis: 74 RPA, 18 LGA, 20 PCA, and 28 CPA. Transplants were primarily performed with whole livers (98%) in recipients with median (IQR) age 58 (49-63) years, model for end-stage liver disease score 17 (14-24), and cold ischemia 431 (360-505) minutes. Post-operatively, 49% of recipients developed acute kidney injury, 16% diuretic-responsive ascites, 9% refractory ascites (29% with CPA, p <0.001), and 10% variceal hemorrhage (25% with CPA, p = 0.002). After a median follow-up of 22 (4-67) months, patient and graft 1-/3-/5-year survival rates were 71/67/61% and 69/63/57%, respectively. On multivariate Cox proportional hazards analysis, the only factor significantly and independently associated with all-cause graft loss was non-physiological portal vein reconstruction in which all graft portal inflow arose from recipient systemic circulation (hazard ratio 6.639, 95% CI 2.159-20.422, p = 0.001). Conclusions Alternative forms of portal vein anastomosis achieving physiological portal inflow (i.e., at least some recipient splanchnic blood flow reaching transplant graft) offer acceptable post-transplant results in LT candidates with complex PVT. On the contrary, non-physiological portal vein anastomoses fail to resolve portal hypertension and should not be performed.

 Fuente: Journal of Hepatology, 2023, 78, 794-804

Editorial: Elsevier

 Año de publicación: 2023

Nº de páginas: 12

Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.jhep.2023.01.007

ISSN: 0168-8278,1600-0641

Url de la publicación: https://doi.org/10.1016/j.jhep.2023.01.007

Autores/as

FUNDADORA, YILIAM

HESSHEIMER, AMELIA J.

DEL PRETE, LUCA

MARONI, LORENZO

LANARI, JACOPO

BARRIOS, ORIANA

CLARYSSE, MATHIAS

GASTACA, MIKEL

BARRERA GÓMEZ, MANUEL

BONADONA, AGNÈS

JANEK, JULIUS

BOSCÀ, ANDREA

ÁLAMO MARTÍNEZ, JOSÉ MARÍA

ZOZAYA, GABRIEL

LÓPEZ GARNICA, DOLORES

MAGISTRI, PAOLO

LEÓN, FRANCISCO

MAGINI, GIULIA

JUAN ANDRES ECHEVERRI CIFUENTES