Orthotopic liver transplantation (OLT) may be feasible even in the presence of diffuse portal vein thrombosis (PVT) in the recipient, providing hepatopetal portal flow to the graft can be ensured. Cavoportal hemitransposition was used in selected cases in which no other salvage solutions were technically possible. We report our experience of two patients with diffuse thrombosis of the entire portal system. One patient also had thrombosis of a previous portacaval shunt with a synthetic interposition graft. Portal pedicle dissection and native hepatectomy (with or without vena cava removal) appeared difficult. Bleeding from the exposed area was severe, and in one case, a new laparotomy was necessary to stop the abdominal hemorrhage. The postoperative course was complicated by severe ascites (with fluid infection and surgically drained suprahepatic abscess in one case), renal insufficiency (requiring dialysis in one case), esophagogastric variceal bleeding (needing several sessions of endoscopic treatment), and bronchopneumonic infections (in one case, superinfection with Aspergillus fumigatus despite amphotericin B lipid complex therapy led to the patient's death from multiorgan failure). Our experience was compared with 17 other cases in the literature. Etiologic factors, preoperative diagnostics, surgical problems, and postoperative complications are focused on and discussed. Diffuse PVT no longer appears to be an absolute contraindication to OLT, although cavoportal hemitransposition needs further experience and long-term follow-up.

Cavoportal hemitransposition: A successful way to overcome the problem of total portosplenomesenteric thrombosis in liver transplantation / Gerunda, G.; Merenda, R; Neri, D; Angeli, P; Barbazza, F; Valmasoni, M; Zangrandi, F; Gangemi, A; Miotto, D; Gagliesi, A; MAFFEI FACCIOLI, A. - In: LIVER TRANSPLANTATION. - ISSN 1527-6465. - STAMPA. - 8:1(2002), pp. 72-75. [10.1053/jlts.2002.30404]

Cavoportal hemitransposition: A successful way to overcome the problem of total portosplenomesenteric thrombosis in liver transplantation

Gerunda, G.;
2002

Abstract

Orthotopic liver transplantation (OLT) may be feasible even in the presence of diffuse portal vein thrombosis (PVT) in the recipient, providing hepatopetal portal flow to the graft can be ensured. Cavoportal hemitransposition was used in selected cases in which no other salvage solutions were technically possible. We report our experience of two patients with diffuse thrombosis of the entire portal system. One patient also had thrombosis of a previous portacaval shunt with a synthetic interposition graft. Portal pedicle dissection and native hepatectomy (with or without vena cava removal) appeared difficult. Bleeding from the exposed area was severe, and in one case, a new laparotomy was necessary to stop the abdominal hemorrhage. The postoperative course was complicated by severe ascites (with fluid infection and surgically drained suprahepatic abscess in one case), renal insufficiency (requiring dialysis in one case), esophagogastric variceal bleeding (needing several sessions of endoscopic treatment), and bronchopneumonic infections (in one case, superinfection with Aspergillus fumigatus despite amphotericin B lipid complex therapy led to the patient's death from multiorgan failure). Our experience was compared with 17 other cases in the literature. Etiologic factors, preoperative diagnostics, surgical problems, and postoperative complications are focused on and discussed. Diffuse PVT no longer appears to be an absolute contraindication to OLT, although cavoportal hemitransposition needs further experience and long-term follow-up.
2002
8
1
72
75
Cavoportal hemitransposition: A successful way to overcome the problem of total portosplenomesenteric thrombosis in liver transplantation / Gerunda, G.; Merenda, R; Neri, D; Angeli, P; Barbazza, F; Valmasoni, M; Zangrandi, F; Gangemi, A; Miotto, D; Gagliesi, A; MAFFEI FACCIOLI, A. - In: LIVER TRANSPLANTATION. - ISSN 1527-6465. - STAMPA. - 8:1(2002), pp. 72-75. [10.1053/jlts.2002.30404]
Gerunda, G.; Merenda, R; Neri, D; Angeli, P; Barbazza, F; Valmasoni, M; Zangrandi, F; Gangemi, A; Miotto, D; Gagliesi, A; MAFFEI FACCIOLI, A
File in questo prodotto:
File Dimensione Formato  
Liver Transplantation - 2004 - Gerunda - Cavoportal hemitransposition A successful way to overcome the problem of total.pdf

Open access

Tipologia: Versione pubblicata dall'editore
Dimensione 69.08 kB
Formato Adobe PDF
69.08 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/453382
Citazioni
  • ???jsp.display-item.citation.pmc??? 5
  • Scopus 44
  • ???jsp.display-item.citation.isi??? 37
social impact