Endovascular Treatment, Liver Transplantation
Conditions
Brief summary
Background: To evaluate the safety and efficacy of intraoperative endovascular treatment (EVT) using the donor ligamentum teres hepatis (LTH) approach for Yerdel grade III/IV portal vein thrombosis (PVT) during liver transplantation (LT), a condition that poses a major challenge in complex surgeries. Methods: This single-center retrospective cohort study included some patients with grade III/IV PVT who underwent LT and were divided into two periods: in both periods, patients underwent modified eversion thrombectomy. However, in Period 1 (2016-2019), nonanatomical anastomosis was performed if portal flow was insufficient, and in Period 2 (2019-2024), patients with persistent hypoperfusion underwent additional LTH-based EVT (stenting or shunt occlusion). Perioperative outcomes (operative time, anhepatic phase, and anastomosis type) and long-term outcomes (graft survival and complication rates) were compared between groups.
Interventions
PROCEDUREnonanatomical anastomosis
In Period 1 (2016-2019, n=41), nonanatomical anastomosis was performed if portal flow was insufficient.
PROCEDURELTH-based EVT
In Period 2 (2019-2024, n=34), patients with persistent hypoperfusion underwent additional LTH-based EVT (stenting or shunt occlusion)
Sponsors
Chiyi Chen
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients (aged ≥18 years). * Patients underwent deceased-donor liver transplantation. * At Tianjin First Central Hospital between February 2016 and December 2024. * Identified recipients with Yerdel grade III/IV PVT, which was confirmed by multiphase contrast-enhanced CT, indirect portography, and intraoperative evaluation
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Operative Time | Intraoperative | Operative time refers to the duration from the initial surgical incision to the completion of skin closure. |
| Anhepatic Phase Time | Intraoperative | The anhepatic phase time is the critical period during liver transplant surgery when the patient's native liver has been removed and the donor liver has not yet been reperfused. |
| Rate of Nonanatomical Reconstruction | Intraoperative | The rate of nonanatomical resection refers to the frequency with which a surgical procedure removes a tumor without following the boundaries of the organ's functional anatomical units. |
| Delayed Graft Function | Within 7 days postoperatively | Delayed graft function is a common complication following kidney transplantation where the transplanted organ does not function immediately, often necessitating dialysis within the first week post-surgery. |
| Portal Vein Complications | From the surgery to the last follow-up (median follow-up 28 months) | Portal vein complications are a serious concern in liver transplantation, encompassing issues such as thrombosis, stenosis, and occlusion that can threaten graft survival and patient life. |
| Graft Survival | 1-year and 3-year postoperatively | Graft survival refers to the continued functional existence of a transplanted organ or tissue within a recipient's body. |
Outcome results
None listed