Surgical complications following liver transplantation in patients with portal vein thrombosis-a single-center perspective

Rajeev Sharma, Randeep Kashyap, Ashok Jain, Saman Safadjou, Maureen Graham, Alok Kumar Dwivedi, Mark Orloff

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25 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)520-527
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume14
Issue number3
DOIs
StatePublished - Mar 1 2010

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Portal Vein
Liver Transplantation
Thrombosis
Tissue Donors
Thrombectomy
Control Groups
Confounding Factors (Epidemiology)
Liver
Erythrocytes
Transplants

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

Cite this

Sharma, Rajeev ; Kashyap, Randeep ; Jain, Ashok ; Safadjou, Saman ; Graham, Maureen ; Dwivedi, Alok Kumar ; Orloff, Mark. / Surgical complications following liver transplantation in patients with portal vein thrombosis-a single-center perspective. In: Journal of Gastrointestinal Surgery. 2010 ; Vol. 14, No. 3. pp. 520-527.
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abstract = "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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Surgical complications following liver transplantation in patients with portal vein thrombosis-a single-center perspective. / Sharma, Rajeev; Kashyap, Randeep; Jain, Ashok; Safadjou, Saman; Graham, Maureen; Dwivedi, Alok Kumar; Orloff, Mark.

In: Journal of Gastrointestinal Surgery, Vol. 14, No. 3, 01.03.2010, p. 520-527.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Surgical complications following liver transplantation in patients with portal vein thrombosis-a single-center perspective

AU - Sharma, Rajeev

AU - Kashyap, Randeep

AU - Jain, Ashok

AU - Safadjou, Saman

AU - Graham, Maureen

AU - Dwivedi, Alok Kumar

AU - Orloff, Mark

PY - 2010/3/1

Y1 - 2010/3/1

N2 - 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.

AB - 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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