Unique multidisciplinary approach in living donor liver transplantation to achieve total physiological revascularization in a patient with complete occlusion of portal vein system with combined chronic and subacute thrombosis.

IF 8.9 2区 医学 Q1 SURGERY American Journal of Transplantation Pub Date : 2024-10-04 DOI:10.1016/j.ajt.2024.09.033
Francesca Albanesi, Jae-Yoon Kim, Kwang-Woong Lee, YoungRok Choi, Nam-Joon Yi, Suk-Kyun Hong, Kyung-Suk Suh
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Abstract

Patients receiving liver transplantation in a setting of complete portal vein (PV) and superior mesenteric vein (SMV) thrombosis (Yerdel grade 4) experience lower outcomes after surgery; prognosis is independently influenced by the portal flow reconstruction technique, showing better outcomes in physiological surgical strategies. We describe a case of living donor liver transplantation in which the patient could not receive common physiological reconstructions preoperatively due to multiple small collaterals and extensive thrombosis down to first branches of SMV. We performed thromboendovenectomy of the PV and SMV first, but acute thrombosis developed recurrently even with interposition venous homograft between pericholedochal collateral vein and proximal recipient PV. Immediate after surgery, an intervention radiologist performed stent insertion into 3 stenotic points. Through multidisciplinary approach, complete physiological recanalization was obtained with normal liver function.

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在活体肝移植手术中采用独特的多学科方法,为一名门静脉系统完全闭塞并合并慢性和亚急性血栓形成的患者实现完全生理性血管再通。
在门静脉(PV)和肠系膜上静脉(SMV)完全血栓形成(耶德尔4级)的情况下接受肝移植的患者术后预后较差;预后受门静脉血流重建技术的独立影响,生理手术策略的预后较好。我们描述了一例活体肝移植病例,患者术前无法接受普通的生理性重建,原因是存在多条小分支和SMV第一分支的广泛血栓形成。我们首先对门静脉和 SMV 进行了血栓内静脉切除术,但即使在胆总管旁静脉和受体门静脉近端之间进行了静脉同种异体移植,急性血栓仍反复形成。手术后,放射科介入医生立即对 3 个狭窄点进行了支架植入术。通过多学科合作,手术后肝功能恢复正常,实现了完全的生理性再通畅。
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来源期刊
CiteScore
18.70
自引率
4.50%
发文量
346
审稿时长
26 days
期刊介绍: The American Journal of Transplantation is a leading journal in the field of transplantation. It serves as a forum for debate and reassessment, an agent of change, and a major platform for promoting understanding, improving results, and advancing science. Published monthly, it provides an essential resource for researchers and clinicians worldwide. The journal publishes original articles, case reports, invited reviews, letters to the editor, critical reviews, news features, consensus documents, and guidelines over 12 issues a year. It covers all major subject areas in transplantation, including thoracic (heart, lung), abdominal (kidney, liver, pancreas, islets), tissue and stem cell transplantation, organ and tissue donation and preservation, tissue injury, repair, inflammation, and aging, histocompatibility, drugs and pharmacology, graft survival, and prevention of graft dysfunction and failure. It also explores ethical and social issues in the field.
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