Novel classification of non-malignant portal vein thrombosis: A guide to surgical decision-making during liver transplantation

Abstract Nontumoral PVT is present at liver transplantation in 5% to 26% of cirrhotic patients, and the prevalence of complex PVT as defined here (Grade 4 Yerdel, and Grade 3,4 Jamieson and Charco) has been reported in 0% to 2.2%. Adequate portal inflow is mandatory to ensure graft and patient survival after liver transplantation. With time, the proposed classifications of non-tumoral chronic PVT have evolved from being anatomy-based to also incorporating functional parameters. However, none of the currently proposed classifications are directed towards decision-making, as regards choice of inflow to the graft during LT and the outcomes there of. The present scoping review i) addresses the limits of the currently available classifications in terms of surgical decisiveness, ii) clarifies the concept of physiological or non-physiological nature of portal inflow reconstruction, and subsequently, iii) proposes a new classification of non-tumoral PVT in candidates for LT; to help tailor the surgical strategy in an individual patient, so as to provide portal inflow to the graft together with control of pre-hepatic portal hypertension whenever feasible.