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

Fecha de publicación: 20/01/2023 Fecha Ahead of Print: 20/01/2023

Autores de IIS La Fe

Andrea Boscà Robledo

Autor
Rafael López Andújar

Autor

Participantes ajenos a IIS La Fe

Fundora, Yiliam
Hessheimer, Amelia J.
Del Prete, Luca
Maroni, Lorenzo
Lanari, Jacopo
Barrios, Oriana
Clarysse, Mathias
Gastaca, Mikel
Gomez, Manuel Barrera
Bonadona, Agnes
Janek, Julius
Álamo Martínez JM
Zozaya, Gabriel
Garnica, Dolores Lopez
Magistri, Paolo
Leon, Francisco
Magini, Giulia
Patrono, Damiano
Nicovsky, Jiri
Hakeem, Abdul Rahman
Nadalin, Silvio
McCormack, Lucas
Palacios, Pilar
Zieniewicz, Krzysztof
Blanco, Gerardo
Nuño J
Saborido, Baltasar Perez
Echeverri, Juan
Bynon, J. Steve
Martins, Paulo N.
Lopez, Victor Lopez
Dayangac, Murat
Lodge JPA
Romagnoli, Renato
Toso, Christian
Santoyo, Julio
Di Benedetto, Fabrizio
Gomez-Gavara, Concepcion
Rotellar, Fernando
Gomez-Bravo, Miguel Angel
Girard, Edouard
Valdivieso, Andres
Pirenne, Jacques
Llado, Laura
Germani, Giacomo
Cescon, Matteo
Hashimoto, Koji
Quintini, Cristiano
Cillo, Umberto
Polak, Wojciech G.
Fondevila, Constantino

Grupos

Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Leader

Marina Berenguer Haym

Abstract

BACKGROUND: Complex portal vein thrombosis (PVT) is a challenge in liver transplantation (LT). Extra-anatomical approaches 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 performed with RPA, LGA, PCA, or CPA were recorded and updated through 12/2021. RESULTS: 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 age 58 years [25-75% interquartile range 49-63], MELD 17 [14-24], and cold ischemia 431 minutes [360-505]. Post-operatively, 49% of recipients developed acute kidney injury (AKI), 16% diuretic-responsive ascites, 9% refractory ascites (29% with CPA, P<0.001), and 10% variceal hemorrhage (25% with CPA, P=0.002). After median follow-up of 22 months [4-67], 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 (HR 6.639, 95% CI 2.159-20.422, P=0.001). CONCLUSIONS: Alternative forms of portal vein anastomosis achieving physiological portal inflow (i.e., deriving at least some splanchnic blood to the 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. IMPACT AND IMPLICATIONS: Complex portal vein thrombosis (PVT) is a challenge in liver transplantation. Results of this international, multicenter analysis may be used to guide clinical decisions in transplant candidates with complex PVT. Extra-anatomical portal vein anastomoses deriving at least some recipient splanchnic blood flow to the transplant allograft offer acceptable results. On the other hand, anastomoses that derive only systemic blood flow to the allograft fail to resolve portal hypertension and should not be performed.

Datos de la publicación

ISSN/ISSNe:: 0168-8278, 1600-0641
Tipo:: Article
Páginas:: 794-804
DOI:: 10.1016/j.jhep.2023.01.007
Factor de Impacto:: 7,351 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

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Métricas

Filiaciones

Fundora, Yiliam:: General & Digestive Surgery Service, Hospital Clínic, Barcelona, Spain
Hessheimer, Amelia J.:: General & Digestive Surgery Service, Hospital Clínic, Barcelona, Spain

General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain

CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Del Prete, Luca:: Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
Maroni, Lorenzo:: Hepatobiliary Surgery & Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, Italy
Lanari, Jacopo:: Department of Surgery, Oncology, & Gastroenterology, Hepatobiliary & Liver Transplantation Unit, Padua University Hospital, Padua, Italy
Barrios, Oriana:: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, Barcelona, Spain
Clarysse, Mathias:: Abdominal Transplant Surgery, UZ Leuven, KUL, Leuven, Belgium
Gastaca, Mikel:: Hepatobiliary Surgery & Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bilbao, Spain
Gomez, Manuel Barrera:: Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
Bonadona, Agnes:: Grenoble Alpes University, CHU Grenoble Alpes, Digestive Surgery & Liver Transplantation, Grenoble, France
Bosca, Andrea:: Hepatobiliary Surgery & Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Álamo Martínez JM:: Hospital Universitario Virgen del Rocío, Seville, Spain
Zozaya, Gabriel:: Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
Garnica, Dolores Lopez:: Hospital Universitario Vall D'Hebrón, Barcelona, Spain
Magistri, Paolo:: Hepato-pancreato-biliary Surgery & Liver Transplantation Unit, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
Leon, Francisco:: Hospital Regional Universitario de Málaga, Málaga, Spain
Magini, Giulia:: Hôpitaux Universitaires de Genève, Geneva, Switzerland
Patrono, Damiano:: General Surgery 2U - Liver Transplant Centre, AOU Città della Salute e della Scienza di Torino, Torino, Italy
Hakeem, Abdul Rahman:: Department of HPB and Liver Transplant Surgery, St. James's University Hospital, Leeds, UK
Nadalin, Silvio:: University of Tübingen, Tübingen, Germany
McCormack, Lucas:: Hospital Alemán, Buenos Aires, Argentina
Palacios, Pilar:: Hospital Clinico Universitario de Zaragoza, Zaragoza, Spain
Zieniewicz, Krzysztof:: Medical University of Warsaw, Warsaw, Poland
Blanco, Gerardo:: Hospital Universitario de Badajoz, Universidad de Extremadura, Badajoz, Spain
Nuño J:: Hospital Universitario Ramón y Cajal, Madrid, Spain
Saborido, Baltasar Perez:: Hepatobiliopancreatic Surgery & Liver Transplant Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
Echeverri, Juan:: Hospital Universitario Marqués de Valdecilla, Santander, Spain
Bynon, J. Steve:: University of Texas Houston - Memorial Hermann TMC, Houston, Texas, USA
Martins, Paulo N.:: University of Massachusetts - Memorial Medical Center, Worcester, Massachusetts, USA
Lopez, Victor Lopez:: Department of Surgery & Transplantation, Hospital Clínico Universitario Virgen de la Arrixaca, Murcian Institue of Biosanitary Research (IMIB), Murcia, Spain
Dayangac, Murat:: Medipol University Hospital Center for Organ Transplantation, Istanbul, Turkey
Lodge JPA:: Department of HPB and Liver Transplant Surgery, St. James's University Hospital, Leeds, UK
Romagnoli, Renato:: General Surgery 2U - Liver Transplant Centre, AOU Città della Salute e della Scienza di Torino, Torino, Italy
Toso, Christian:: Hôpitaux Universitaires de Genève, Geneva, Switzerland
Santoyo, Julio:: Hospital Regional Universitario de Málaga, Málaga, Spain
Di Benedetto, Fabrizio:: Hepato-pancreato-biliary Surgery & Liver Transplantation Unit, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
Gomez-Gavara, Concepcion:: Hospital Universitario Vall D'Hebrón, Barcelona, Spain
Rotellar, Fernando:: Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
Gomez-Bravo, Miguel Angel:: Hospital Universitario Virgen del Rocío, Seville, Spain
Andujar, Rafael Lopez:: Hepatobiliary Surgery & Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Girard, Edouard:: Grenoble Alpes University, CHU Grenoble Alpes, Digestive Surgery & Liver Transplantation, Grenoble, France
Valdivieso, Andres:: Hepatobiliary Surgery & Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Bilbao, Spain
Pirenne, Jacques:: Abdominal Transplant Surgery, UZ Leuven, KUL, Leuven, Belgium
Llado, Laura:: Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, Barcelona, Spain
Germani, Giacomo:: Department of Surgery, Oncology, & Gastroenterology, Hepatobiliary & Liver Transplantation Unit, Padua University Hospital, Padua, Italy
Cescon, Matteo:: Hepatobiliary Surgery & Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, Italy
Hashimoto, Koji:: Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
Quintini, Cristiano:: Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
Cillo, Umberto:: Department of Surgery, Oncology, & Gastroenterology, Hepatobiliary & Liver Transplantation Unit, Padua University Hospital, Padua, Italy
Fondevila, Constantino:: General & Digestive Surgery Service, Hospital Clínic, Barcelona, Spain

General & Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain

CIBERehd, Instituto de Salud Carlos III, Madrid, Spain

Keywords

cavoportal anastomosis; cavoportal hemitransposition; liver transplantation; multivisceral transplantation; portal hypertension; portal vein thrombosis; renoportal anastomosis