Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques
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...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-03-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/7/2457 |
| _version_ | 1797607667692208128 |
|---|---|
| author | Domenico Pinelli Matteo Cescon Matteo Ravaioli Flavia Neri Annalisa Amaduzzi Matteo Serenari Greta Carioli Antonio Siniscalchi Michele Colledan |
| author_facet | Domenico Pinelli Matteo Cescon Matteo Ravaioli Flavia Neri Annalisa Amaduzzi Matteo Serenari Greta Carioli Antonio Siniscalchi Michele Colledan |
| author_sort | Domenico Pinelli |
| collection | DOAJ |
| description | 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 (<i>p</i> = 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; <i>p</i> = 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. |
| first_indexed | 2024-03-11T05:34:04Z |
| format | Article |
| id | doaj.art-aa7378a90cf34089ab7e713cbdbeb8e2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T05:34:04Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-aa7378a90cf34089ab7e713cbdbeb8e22023-11-17T16:57:24ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01127245710.3390/jcm12072457Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical TechniquesDomenico Pinelli0Matteo Cescon1Matteo Ravaioli2Flavia Neri3Annalisa Amaduzzi4Matteo Serenari5Greta Carioli6Antonio Siniscalchi7Michele Colledan8Department of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, ItalyHepatobiliary and Transplant Unit, Policlinico Sant’Orsola IRCCS, University of Bologna, 40138 Bologna, ItalyHepatobiliary and Transplant Unit, Policlinico Sant’Orsola IRCCS, University of Bologna, 40138 Bologna, ItalyDepartment of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, ItalyDepartment of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, ItalyHepatobiliary and Transplant Unit, Policlinico Sant’Orsola IRCCS, University of Bologna, 40138 Bologna, ItalyFROM Research Foundation, Papa Giovanni XXIII Hospital, 24127 Bergamo, ItalyAnesthesia and Intensive Care Unit, Policlinico Sant’Orsola IRCCS, University of Bologna, 40138 Bologna, ItalyDepartment of Organ Failure and Transplantation, Papa Giovanni XXIII Hospital, 24127 Bergamo, ItalySurgical 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 (<i>p</i> = 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; <i>p</i> = 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.https://www.mdpi.com/2077-0383/12/7/2457Yerdel gradereno-portal anastomosisporto-mesenteric bypassspleno-portal shuntthrombectomy |
| spellingShingle | Domenico Pinelli Matteo Cescon Matteo Ravaioli Flavia Neri Annalisa Amaduzzi Matteo Serenari Greta Carioli Antonio Siniscalchi Michele Colledan Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques Journal of Clinical Medicine Yerdel grade reno-portal anastomosis porto-mesenteric bypass spleno-portal shunt thrombectomy |
| title | Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques |
| title_full | Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques |
| title_fullStr | Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques |
| title_full_unstemmed | Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques |
| title_short | Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques |
| title_sort | liver transplantation in patients with portal vein thrombosis revisiting outcomes according to surgical techniques |
| topic | Yerdel grade reno-portal anastomosis porto-mesenteric bypass spleno-portal shunt thrombectomy |
| url | https://www.mdpi.com/2077-0383/12/7/2457 |
| work_keys_str_mv | AT domenicopinelli livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques AT matteocescon livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques AT matteoravaioli livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques AT flavianeri livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques AT annalisaamaduzzi livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques AT matteoserenari livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques AT gretacarioli livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques AT antoniosiniscalchi livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques AT michelecolledan livertransplantationinpatientswithportalveinthrombosisrevisitingoutcomesaccordingtosurgicaltechniques |