Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation

Ernesto P. Molmenti, Thomas W. Roodhouse, Hebe Molmenti, Kshama Jaiswal, Ghap Jung, Shigeru Marubashi, Edmund Q. Sanchez, Brian Gogel, Marlon F. Levy, Robert M. Goldstein, Carlos G. Fasola, Eric E. Elliott, Nevenka Bursac, David Mulligan, Thomas A. Gonwa, Goran B. Klintmalm

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

Objective: To determine the efficacy of portal thrombendvenectomy in cases of portal vein thrombosis at the time of orthotopic liver transprantation. Summary Background Data: Portal vein thrombosis (PVT) has been reported to have an incidence of 2% to 39% in end-stage liver disease. Multiple techniques have been suggested to treat this finding. Several reports have suggested suboptimal results after liver transplantation in recipients with PVT. Methods: The authors prospectively collected data on 1,546 patients who underwent an initial orthotopic liver transplant at the authors' institution between December 1984 and October 1999. There were 820 male patients and 726 female patients. All recipients received either cyclosporine or tacrolimus immunosuppression. Intraoperative flows of the portal vein and hepatic artery were routinely measured. Duplex sonography was routinely performed on the first postoperative day and routinely 1, 2, 5, and 10 years after transplantation. Eighty-five patients underwent thrombendvenectomy for organized thrombus partially or completely occluding the portal vein. Postoperative treatment included low-molecular-weight dextran for 48 hours and daily aspirin for 3 months. There were 53 male patients and 32 female patients. The PVT group was compared with a control group consisting of transplant recipients without PVT. Results: When compared with the control group. PVT patients were older at the time of transplantation and had a higher incidence of liver disease secondary to cryptogenic cirrhosis and Laennec's cirrhosis. There were no significant differences among both groups for 1-, 3-, and 6-year patient and graft survival rates. Conclusions: Thrombendvenectomy provides a rapid resolution of an otherwise complex problem. It is the authors' procedure of choice in cases of organized PVT at the time of transplantation. Operative time and length of stay in the intensive care unit are not prolonged, and patient and graft survival rates are not compromised.

Original languageEnglish (US)
Pages (from-to)292-296
Number of pages5
JournalAnnals of Surgery
Volume235
Issue number2
DOIs
StatePublished - 2002
Externally publishedYes

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Portal Vein
Liver Transplantation
Thrombosis
Transplantation
Graft Survival
Survival Rate
Control Groups
End Stage Liver Disease
Liver
Hepatic Artery
Incidence
Tacrolimus
Operative Time
Dextrans
Immunosuppression
Cyclosporine
Aspirin
Intensive Care Units
Liver Diseases
Ultrasonography

ASJC Scopus subject areas

  • Surgery

Cite this

Molmenti, E. P., Roodhouse, T. W., Molmenti, H., Jaiswal, K., Jung, G., Marubashi, S., ... Klintmalm, G. B. (2002). Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. Annals of Surgery, 235(2), 292-296. https://doi.org/10.1097/00000658-200202000-00019

Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. / Molmenti, Ernesto P.; Roodhouse, Thomas W.; Molmenti, Hebe; Jaiswal, Kshama; Jung, Ghap; Marubashi, Shigeru; Sanchez, Edmund Q.; Gogel, Brian; Levy, Marlon F.; Goldstein, Robert M.; Fasola, Carlos G.; Elliott, Eric E.; Bursac, Nevenka; Mulligan, David; Gonwa, Thomas A.; Klintmalm, Goran B.

In: Annals of Surgery, Vol. 235, No. 2, 2002, p. 292-296.

Research output: Contribution to journalArticle

Molmenti, EP, Roodhouse, TW, Molmenti, H, Jaiswal, K, Jung, G, Marubashi, S, Sanchez, EQ, Gogel, B, Levy, MF, Goldstein, RM, Fasola, CG, Elliott, EE, Bursac, N, Mulligan, D, Gonwa, TA & Klintmalm, GB 2002, 'Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation', Annals of Surgery, vol. 235, no. 2, pp. 292-296. https://doi.org/10.1097/00000658-200202000-00019
Molmenti, Ernesto P. ; Roodhouse, Thomas W. ; Molmenti, Hebe ; Jaiswal, Kshama ; Jung, Ghap ; Marubashi, Shigeru ; Sanchez, Edmund Q. ; Gogel, Brian ; Levy, Marlon F. ; Goldstein, Robert M. ; Fasola, Carlos G. ; Elliott, Eric E. ; Bursac, Nevenka ; Mulligan, David ; Gonwa, Thomas A. ; Klintmalm, Goran B. / Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. In: Annals of Surgery. 2002 ; Vol. 235, No. 2. pp. 292-296.
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abstract = "Objective: To determine the efficacy of portal thrombendvenectomy in cases of portal vein thrombosis at the time of orthotopic liver transprantation. Summary Background Data: Portal vein thrombosis (PVT) has been reported to have an incidence of 2{\%} to 39{\%} in end-stage liver disease. Multiple techniques have been suggested to treat this finding. Several reports have suggested suboptimal results after liver transplantation in recipients with PVT. Methods: The authors prospectively collected data on 1,546 patients who underwent an initial orthotopic liver transplant at the authors' institution between December 1984 and October 1999. There were 820 male patients and 726 female patients. All recipients received either cyclosporine or tacrolimus immunosuppression. Intraoperative flows of the portal vein and hepatic artery were routinely measured. Duplex sonography was routinely performed on the first postoperative day and routinely 1, 2, 5, and 10 years after transplantation. Eighty-five patients underwent thrombendvenectomy for organized thrombus partially or completely occluding the portal vein. Postoperative treatment included low-molecular-weight dextran for 48 hours and daily aspirin for 3 months. There were 53 male patients and 32 female patients. The PVT group was compared with a control group consisting of transplant recipients without PVT. Results: When compared with the control group. PVT patients were older at the time of transplantation and had a higher incidence of liver disease secondary to cryptogenic cirrhosis and Laennec's cirrhosis. There were no significant differences among both groups for 1-, 3-, and 6-year patient and graft survival rates. Conclusions: Thrombendvenectomy provides a rapid resolution of an otherwise complex problem. It is the authors' procedure of choice in cases of organized PVT at the time of transplantation. Operative time and length of stay in the intensive care unit are not prolonged, and patient and graft survival rates are not compromised.",
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T1 - Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation

AU - Molmenti, Ernesto P.

AU - Roodhouse, Thomas W.

AU - Molmenti, Hebe

AU - Jaiswal, Kshama

AU - Jung, Ghap

AU - Marubashi, Shigeru

AU - Sanchez, Edmund Q.

AU - Gogel, Brian

AU - Levy, Marlon F.

AU - Goldstein, Robert M.

AU - Fasola, Carlos G.

AU - Elliott, Eric E.

AU - Bursac, Nevenka

AU - Mulligan, David

AU - Gonwa, Thomas A.

AU - Klintmalm, Goran B.

PY - 2002

Y1 - 2002

N2 - Objective: To determine the efficacy of portal thrombendvenectomy in cases of portal vein thrombosis at the time of orthotopic liver transprantation. Summary Background Data: Portal vein thrombosis (PVT) has been reported to have an incidence of 2% to 39% in end-stage liver disease. Multiple techniques have been suggested to treat this finding. Several reports have suggested suboptimal results after liver transplantation in recipients with PVT. Methods: The authors prospectively collected data on 1,546 patients who underwent an initial orthotopic liver transplant at the authors' institution between December 1984 and October 1999. There were 820 male patients and 726 female patients. All recipients received either cyclosporine or tacrolimus immunosuppression. Intraoperative flows of the portal vein and hepatic artery were routinely measured. Duplex sonography was routinely performed on the first postoperative day and routinely 1, 2, 5, and 10 years after transplantation. Eighty-five patients underwent thrombendvenectomy for organized thrombus partially or completely occluding the portal vein. Postoperative treatment included low-molecular-weight dextran for 48 hours and daily aspirin for 3 months. There were 53 male patients and 32 female patients. The PVT group was compared with a control group consisting of transplant recipients without PVT. Results: When compared with the control group. PVT patients were older at the time of transplantation and had a higher incidence of liver disease secondary to cryptogenic cirrhosis and Laennec's cirrhosis. There were no significant differences among both groups for 1-, 3-, and 6-year patient and graft survival rates. Conclusions: Thrombendvenectomy provides a rapid resolution of an otherwise complex problem. It is the authors' procedure of choice in cases of organized PVT at the time of transplantation. Operative time and length of stay in the intensive care unit are not prolonged, and patient and graft survival rates are not compromised.

AB - Objective: To determine the efficacy of portal thrombendvenectomy in cases of portal vein thrombosis at the time of orthotopic liver transprantation. Summary Background Data: Portal vein thrombosis (PVT) has been reported to have an incidence of 2% to 39% in end-stage liver disease. Multiple techniques have been suggested to treat this finding. Several reports have suggested suboptimal results after liver transplantation in recipients with PVT. Methods: The authors prospectively collected data on 1,546 patients who underwent an initial orthotopic liver transplant at the authors' institution between December 1984 and October 1999. There were 820 male patients and 726 female patients. All recipients received either cyclosporine or tacrolimus immunosuppression. Intraoperative flows of the portal vein and hepatic artery were routinely measured. Duplex sonography was routinely performed on the first postoperative day and routinely 1, 2, 5, and 10 years after transplantation. Eighty-five patients underwent thrombendvenectomy for organized thrombus partially or completely occluding the portal vein. Postoperative treatment included low-molecular-weight dextran for 48 hours and daily aspirin for 3 months. There were 53 male patients and 32 female patients. The PVT group was compared with a control group consisting of transplant recipients without PVT. Results: When compared with the control group. PVT patients were older at the time of transplantation and had a higher incidence of liver disease secondary to cryptogenic cirrhosis and Laennec's cirrhosis. There were no significant differences among both groups for 1-, 3-, and 6-year patient and graft survival rates. Conclusions: Thrombendvenectomy provides a rapid resolution of an otherwise complex problem. It is the authors' procedure of choice in cases of organized PVT at the time of transplantation. Operative time and length of stay in the intensive care unit are not prolonged, and patient and graft survival rates are not compromised.

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