Introduction: Portal vein thrombosis (PVT) was once considered a contraindication for liver transplantation (LTx) because of technical difficulties. Though no longer a contraindication, it remains a risk factor. Aim: A study of surgical complications following LTx in patients with and without PVT. Patients and methods: A retrospective review of 1,171 consecutive patients who underwent LTx between June 1995 and June 2007 was performed, and 78 recipients with PVT (study group) were compared with a stratified random sample of 78 contemporous recipients without PVT (control group) for postoperative complications. Both groups were comparable with respect to age, sex, race, and other confounding variables. Results: The rate of primary nonfunction (PNF) in the study and control groups was 9. 0% and 1. 3%, (p = 0. 063), while that of retransplantation was 17. 9% and 7. 7% (p = 0. 055), respectively. The mean donor risk index (DRI) among the patients with and without PNF in the study group was 2. 58 ± 0. 44 and 2. 08 ± 0. 42, respectively (p = 0. 014). A significantly higher number of packed red blood cells and fresh frozen plasma transfusions were observed in study group compared to controls (p = 0. 012, 0. 007, respectively). Conclusion: A higher rate of PNF was related to the complexity of the surgical procedure and the use of donor livers with a high DRI. Higher rates of PNF eventually led to a higher rate of retransplant. A strategy of offering donor livers with a low DRI might be helpful in decreasing the rate of PNF. Further, a PV interposition graft in difficult cases instead of thrombectomy could lead to a lower rethrombosis rate.
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