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Portal Vein Complications After Adult Living Donor Liver Transplantation: Time of Onset and Deformity Patterns Affect Long‐Term Outcomes
Author(s) -
Sambommatsu Yuzuru,
Shimata Keita,
Ibuki Sho,
Narita Yasuko,
Isono Kaori,
Honda Masaki,
Irie Tomoaki,
Kadohisa Masashi,
Kawabata Seiichi,
Yamamoto Hidekazu,
Sugawara Yasuhiko,
Ikeda Osamu,
Inomata Yukihiro,
Hibi Taizo
Publication year - 2021
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25977
Subject(s) - medicine , portal vein thrombosis , liver transplantation , surgery , odds ratio , confidence interval , cumulative incidence , transplantation , risk factor , incidence (geometry) , gastroenterology , thrombosis , physics , optics
Portal vein complications (PVCs) after adult living donor liver transplantation (LDLT) are potentially lethal. We categorized PVCs by the time of onset (early versus late, <1 month versus ≥1 month, respectively) and deformity patterns (portal vein stenosis [PVS], portal vein thrombosis [PVT], and portal vein occlusion [PVO]) to establish optimal treatment strategies. Overall, 35/322 (10.9%) recipients developed PVCs between 2000 and 2019. Pretransplant PVT (odds ratio [OR], 15.20; 95% confidence interval [CI], 3.70‐62.40; P < 0.001) was the only independent risk factor for PVS. In contrast, male sex (OR, 5.57; 95% CI, 1.71‐18.20; P = 0.004), pretransplant PVT (OR, 4.79; 95% CI, 1.64‐14.00; P = 0.004), and splenectomy (OR, 3.24; 95% CI, 1.23‐8.57; P = 0.018) were independent risk factors for PVT. PVS was successfully treated with interventional radiology regardless of its time of onset. On the other hand, late PVT and PVO had significantly lower treatment success rates (2/15, 13%) compared with those that occurred in the early period (10/11, 91%) despite aggressive intervention ( P < 0.001). Deformity patterns had a significant impact on the 5‐year cumulative incidence of graft loss as a result of PVC (PVO + Yerdel grades 2‐4 PVT group [n = 16], 41% versus PVS + Yerdel grade 1 PVT group [n = 19], 0%; P = 0.02). In conclusion, late grades 2 to 4 PVT and PVO are refractory to treatment and associated with poor prognoses, whereas PVS has a good prognosis regardless of time of onset. A tailored approach according to the time of onset and deformity patterns of PVC is essential.