“Multiple to one” anastomosis during liver transplantation in recipients with complex portal vein thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Haiming , WEI Lin , QU Wei , ZENG Zhigui , SUN Liying , LIU Ying ,  ZHU Zhijun

Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P. R. China;

Corresponding author：

ZHU Zhijun, Email: zhu-zhijun@outlook.com

Keywords：

portal vein anastomosis; portal vein thrombosis; liver transplantation; portal hypertension; multiple to one anastomosis

DOI：

10.7507/1007-9424.202204005

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To observe the recovery of recipients with complex portal vein thrombosis (CPVT) underwent “multiple to one” anastomosis and patency of portal vein blood flow during liver transplantation, and to ensure the reliability of this method. Methods The clinicopathologic data of the recipients with CPVT underwent “multiple to one” anastomosis in the Beijing Friendship Hospital, Capital Medical University were collected retrospectively. The “multiple to one” portal vein reconstruction was defined as the anastomosis of multiple vessels of portal venous system with the portal vein of graft, or the anastomosis that connected the blood vessel of portal venous system and the left renal vein/inferior vena cava to the portal vein of graft. Results A total of 5 patients were collected, including 1 patient with Yerdel grade 3 thrombosis and 4 patients with Yerdel grade 4 thrombosis. In 3 cases, the left renal vein, inferior vena cava, left renal vein were combined with the parabiliary vein, respectively, in the anastomosis to the donor portal vein. In another 2 cases, portal vein and left renal vein were combined with gastric coronary vein, respectively, in the anastomosis to the donor portal vein. During the follow-up period of 162–865 d, all patients had the stable portal vein blood flow without any symptom of portal hypertension. One patient had thrombosis at the anastomosis with varicose vein, while the anastomosis with left renal vein was unobstructed, which did not affect the donor liver function. Conclusion Multiple blood supply of portal vein is established after “multiple to one” anastomosis, and stability of portal vein blood flow can be maintained after a blood redistribution of portal venous system following liver transplantation.

Citation： ZHANG Haiming, WEI Lin, QU Wei, ZENG Zhigui, SUN Liying, LIU Ying, ZHU Zhijun. “Multiple to one” anastomosis during liver transplantation in recipients with complex portal vein thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 845-849. doi: 10.7507/1007-9424.202204005 Copy

1.	Bettinger D, Sturm L, Pfaff L, et al. Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. J Hepatol, 2021, 74(6): 1362-1372.
2.	Henry Z, Patel K, Patton H, et al. AGA clinical practice update on management of bleeding gastric varices: expert review. Clin Gastroenterol Hepatol, 2021, 19(6): 1098-1107.
3.	Lin JA, Gardner JM, Kolli KP, et al. Surgical, interventional, and medical palliation of portal hypertension. Am Surg, 2020, 86(11): 1467-1472.
4.	Gallo A, Dedionigi C, Civitelli C, et al. Optimal management of cirrhotic ascites: a review for internal medicine physicians. J Transl Int Med, 2020, 8(4): 220-236.
5.	Chen H, Turon F, Hernández-Gea V, et al. Nontumoral portal vein thrombosis in patients awaiting liver transplantation. Liver Transpl, 2016, 22(3): 352-365.
6.	Gadani S, Partovi S, Levitin A, et al. Narrative review of portal vein thrombosis in cirrhosis: pathophysiology, diagnosis, and management from an interventional radiology perspective. Cardiovasc Diagn Ther, 2022, 12(1): 135-146.
7.	Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation, 2000, 69(9): 1873-1881.
8.	Jamieson NV. Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation, 2000, 69(9): 1772-1774.
9.	Moon DB, Lee SG, Ahn CS, et al. Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis. Liver Transpl, 2014, 20(5): 612-615.
10.	Sheil AG, Stephen MS, Chui AK, et al. A liver transplantation technique in a patient with a thrombosed portal vein and a functioning renal-lieno shunt. Clin Transplant, 1997, 11(1): 71-73.
11.	朱志军, 淮明生, 张雅敏, 等. 肝移植术中受者左肾静脉与供肝门静脉吻合一例及文献复习. 中华器官移植杂志, 2007, 28(6): 365-367.
12.	D’Amico G, Matsushima H, Del Prete L, et al. Long term outcomes and complications of reno-portal anastomosis in liver transplantation: results from a propensity score-based outcome analysis. Transpl Int, 2021, 34(10): 1938-1947.
13.	Kotsifa E, Kykalos S, Machairas N, et al. Management of portal vein thrombosis in cirrhotic patients enlisted for liver transplantation: from diagnosis to treatment (Review). Biomed Rep, 2021, 15(5): 94. doi: 10.3892/br.2021.1470.
14.	Rodríguez-Castro KI, Porte RJ, Nadal E, et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation, 2012, 94(11): 1145-1153.
15.	Zanetto A, Rodriguez-Kastro KI, Germani G, et al. Mortality in liver transplant recipients with portal vein thrombosis—an updated meta-analysis. Transpl Int, 2018, 31(12): 1318-1329.
16.	Pinelli D, Camagni S, Amaduzzi A, et al. Liver transplantation in patients with non-neoplastic portal vein thrombosis: 20 years of experience in a single center. Clin Transplant, 2022, 36(1): e14501. doi: 10.1111/ctr.14501.
17.	Møller S, Bendtsen F. The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis. Liver Int, 2018, 38(4): 570-580.

1. Bettinger D, Sturm L, Pfaff L, et al. Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. J Hepatol, 2021, 74(6): 1362-1372.
2. Henry Z, Patel K, Patton H, et al. AGA clinical practice update on management of bleeding gastric varices: expert review. Clin Gastroenterol Hepatol, 2021, 19(6): 1098-1107.
3. Lin JA, Gardner JM, Kolli KP, et al. Surgical, interventional, and medical palliation of portal hypertension. Am Surg, 2020, 86(11): 1467-1472.
4. Gallo A, Dedionigi C, Civitelli C, et al. Optimal management of cirrhotic ascites: a review for internal medicine physicians. J Transl Int Med, 2020, 8(4): 220-236.
5. Chen H, Turon F, Hernández-Gea V, et al. Nontumoral portal vein thrombosis in patients awaiting liver transplantation. Liver Transpl, 2016, 22(3): 352-365.
6. Gadani S, Partovi S, Levitin A, et al. Narrative review of portal vein thrombosis in cirrhosis: pathophysiology, diagnosis, and management from an interventional radiology perspective. Cardiovasc Diagn Ther, 2022, 12(1): 135-146.
7. Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation, 2000, 69(9): 1873-1881.
8. Jamieson NV. Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation, 2000, 69(9): 1772-1774.
9. Moon DB, Lee SG, Ahn CS, et al. Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis. Liver Transpl, 2014, 20(5): 612-615.
10. Sheil AG, Stephen MS, Chui AK, et al. A liver transplantation technique in a patient with a thrombosed portal vein and a functioning renal-lieno shunt. Clin Transplant, 1997, 11(1): 71-73.
11. 朱志军, 淮明生, 张雅敏, 等. 肝移植术中受者左肾静脉与供肝门静脉吻合一例及文献复习. 中华器官移植杂志, 2007, 28(6): 365-367.
12. D’Amico G, Matsushima H, Del Prete L, et al. Long term outcomes and complications of reno-portal anastomosis in liver transplantation: results from a propensity score-based outcome analysis. Transpl Int, 2021, 34(10): 1938-1947.
13. Kotsifa E, Kykalos S, Machairas N, et al. Management of portal vein thrombosis in cirrhotic patients enlisted for liver transplantation: from diagnosis to treatment (Review). Biomed Rep, 2021, 15(5): 94. doi: 10.3892/br.2021.1470.
14. Rodríguez-Castro KI, Porte RJ, Nadal E, et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation, 2012, 94(11): 1145-1153.
15. Zanetto A, Rodriguez-Kastro KI, Germani G, et al. Mortality in liver transplant recipients with portal vein thrombosis—an updated meta-analysis. Transpl Int, 2018, 31(12): 1318-1329.
16. Pinelli D, Camagni S, Amaduzzi A, et al. Liver transplantation in patients with non-neoplastic portal vein thrombosis: 20 years of experience in a single center. Clin Transplant, 2022, 36(1): e14501. doi: 10.1111/ctr.14501.
17. Møller S, Bendtsen F. The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis. Liver Int, 2018, 38(4): 570-580.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

“Multiple to one” anastomosis during liver transplantation in recipients with complex portal vein thrombosis

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