Portal vein thrombosis during liver transplantation: The risk of extra-anatomical portal vein reconstruction.

Background: This study was designed to analyze the risk of extra-anatomical portal vein reconstruction during liver transplantation (LT) in patient with portal vein thrombosis (PVT).

Methods: Patients who underwent LT between 2008 and 2018 were reviewed. PVT was graded according to the Yerdel system. Risk factor for portal vein complication-free, graft and overall survival were analyzed with multivariate Cox regression.

Results: Seventy out of 1180 patients had PVT. Number of patients who underwent extra-anatomical reconstruction were three (13.0%), three (15.0%), and six (50.0%) with grade II, III and IV thrombosis, respectively. Grade III patients with extra-anatomical reconstruction (HR 10.212, CI 2.475-42.133, P = .001), grade IV with both anatomical (HR 16.991, CI 5.224-54.740, P < .001) and extra-anatomical reconstruction (HR 12.262, CI 2.698-50.666, P = .001) were risk factors for portal vein complication-free survival. Grade IV thrombosis with both anatomical (HR 4.296, CI 1.059-17.430, P = .041) and extra-anatomical reconstruction (HR 7.777, CI 2.461-24.571, P < .001) were risk factors for graft failure. Extra-anatomical reconstruction for both grade I to III (HR 3.638, CI 1.155-11.453, P = .027) and grade IV thrombosis (HR 4.798, CI 1.773-12.982, P = .002) were risk factors for survival.

Conclusions: Grade IV thrombosis and extra-anatomical reconstruction were related to poor prognosis. Therefore, thorough evaluation and planning is required for these patients to improve the outcome.