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Pinelli D, Cescon M, Ravaioli M, Neri F, Amaduzzi A, Serenari M, Carioli G, Siniscalchi A, Colledan M. Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques. J Clin Med 2023; 12:jcm12072457. [PMID: 37048541 PMCID: PMC10095520 DOI: 10.3390/jcm12072457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
Surgical strategies for graft portal vein flow restoration vary from termino-terminal portal vein anastomosis to more complex bypass reconstructions. Although the surgical strategy strongly influences the post-operative outcome, the Yerdel grading is still commonly used to determine the prognosis of patients with portal vein thrombosis (PVT) undergoing liver transplantation (LT). We retrospectively reviewed the cases of LT performed on recipients with complex PVT at two high-volume transplantation centres. We stratified the patients by the type of portal vein reconstruction, termino-terminal portal vein anastomosis (TTA) versus bypass reconstruction (bypass group), and assessed a multivariable survival analysis. The rate of mortality at 90 days was 21.4% for the bypass group compared to 9.8% in the TTA group (p = 0.05). In the multivariable correlation analysis, only a trend for greater risk of early mortality was confirmed in the bypass groups (HR 2.5; p = 0.059). Yerdel grade was uninfluential in the rate of early complications. A wide range of surgical options are available for different situations of PVT which yield an outcome unrelated to the Yerdel grading. An algorithm for PVT management should be based on the technical approach and should include a surgically oriented definition of PVT extension.
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Affiliation(s)
- Domenico Pinelli
- Department of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Matteo Cescon
- Hepatobiliary and Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, 40138 Bologna, Italy
| | - Matteo Ravaioli
- Hepatobiliary and Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, 40138 Bologna, Italy
| | - Flavia Neri
- Department of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Annalisa Amaduzzi
- Department of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Matteo Serenari
- Hepatobiliary and Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, 40138 Bologna, Italy
| | - Greta Carioli
- FROM Research Foundation, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Antonio Siniscalchi
- Anesthesia and Intensive Care Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, 40138 Bologna, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy
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