Liver transplantation with cavoportal or renoportal anastomosis

Doi : GCB-04-2002-26-4-0399-8320-101019-ART1

Daniel Azoulay^[1],

René Adam^[1],

Denis Castaing^[1],

Sorin Muresan^[1],

Achile Essomba^[1],

Eric Vibert^[1],

Eric Savier^[1],

Alaoua Smail^[1],

Luc-Antoine Veilhan^[1],

Henri Bismuth^[1]

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Abstract

Objective

Liver transplantation was contraindicated in patients with diffuse thrombosis of the portal vein until the recent use of graft portal vein reperfusion with the caval flow or one of its tributaries. Long term results of these procedures are reported here.

Patients and methods

Eight patients with diffuse portal vein thrombosis were transplanted by portal reperfusion via latero-terminal anastomosis between the native caval vein and the graft portal vein (2 patients) or termino-terminal beween the native left renal vein and the graft portal vein (6 patients).

Results

Three patients died 3, 3 and 6 months following transplantation from intracerebral hemorrhage, cardiac arrest, and chronic rejection respectively. Three patients had complicated portal hypertension. Five patients were alive at home with a median follow-up of 9 months (2 to 37 months) with normal liver and kinase functions.

Conclusion

Portal reperfusion with the caval vein flow allows tranplantation of patients with diffuse poral vein thrombosis. According to our experience and to the analysis of the literature, reno-portal anastomosis is preferable to cavo-portal reconstruction.