Detalle Publicación

ARTÍCULO

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

Autores: Fundora, Y.; Hessheimer, A. J.; Del Prete, L.; Maroni, L.; Lanari, J.; Barrios, O.; Clarysse, M.; Gastaca, M.; Barrera-Gómez, M.; Bonadona, A.; Janek, J.; Bosca, A.; Álamo-Martínez, J. M.; Zozaya, G.; López-Garnica, D.; Magistri, P.; León, F.; Magini, G.; Patrono, D.; Nicovsky, J.; Hakeem, A. R.; Nadalin, S.; McCormack, L.; Palacios, P.; Zieniewicz, K.; Blanco, G.; Nuno, J.; Pérez-Saborido, B.; Echeverri, J.; Bynon, J. S.; Martins, P. N.; López-López, V.; Dayangac, M.; Lodge, J. P. A.; Romagnoli, R.; Toso, C.; Santoyo, J.; Di Benedetto, F.; Gómez-Gavara, C.; Rotellar Sastre, Fernando; Gómez-Bravo, M. A.; López-Andujar, R.; Girard, E.; Valdivieso, A.; Pirenne, J.; Llado, L.; Germani, G.; Cescon, M.; Hashimoto, K.; Quintini, C.
Título de la revista: JOURNAL OF HEPATOLOGY (ONLINE)
ISSN: 0168-8278
Volumen: 78
Número: 4
Páginas: 794 - 804
Fecha de publicación: 2023
Resumen:
Background & Aims: Complex portal vein thrombosis (PVT) is a challenge in liver transplantation (LT). Extra-anatomical ap-proaches 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 per-formed 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.
DOI: https://doi.org/10.1016/j.jhep.2023.01.007
Impacto:
6 citas en
Google Scholar