3:00 PM Abstract No. 271 Prospective phase II Study of chemoembolization with doxorubicin-eluting microspheres for liver transplantation candidates with hepatocellular carcinoma and marginal hepatic reserve
Nicholas FidelmanCurt JohansonMaureen P. KohiK. KolliRyan KohlbrennerEvan LehrmanAndrew TaylorRobin Kate KelleyFrancis Y. YaoJohn P. RobertsRobert K. Kerlan
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Portal vein thrombosis
Abstract Portal vein thrombosis (PVT) is a heterogeneous condition with multiple possible etiologies and to varying degrees has historically limited candidacy for liver transplant (LT) in the cirrhotic patient population due to resultant difficulties in constructing a robust portal vein anastomosis. While intraoperative approaches to managing PVT are well-described, methods which approximate normal portal physiology are not always feasible depending on the extent of PVT, and other nonphysiologic techniques are linked with substantial morbidity and poor long-term outcomes. Portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR-TIPS) creation is an efficacious method of restoring physiologic portal flow in cirrhotic patients prior to LT allowing for end-to-end PV anastomosis, and is the product of decades-long institutional expertise in TIPS/LT and the support of a multidisciplinary liver tumor board. To follow is a review of the pertinent pathophysiology of PVT in cirrhosis, the rationale leading to the development and subsequent evolution of the PVR-TIPS procedure, technical lessons learned, and a summary of outcomes to date.
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Portosystemic shunt
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Portal vein thrombosis
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Early portal vein thrombosis is a rare but severe posttransplant complication that may lead to graft and/or patient loss. Transjugular intrahepatic portosystemic shunting and local thrombolysis may represent an easy solution to this major complication of liver transplantation.
Portal vein thrombosis
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Portal vein thrombosis
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Abstract High‐grade portal vein thrombosis (PVT) is often considered to be a technically challenging scenario for liver transplantation (LT) and in some centers a relative contraindication. This study compares patients with chronic obliterative PVT who underwent portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR‐TIPS) and subsequent LT to those with partial nonocclusive PVT who underwent LT without an intervention. This institutional review board‐approved study analyzed 49 patients with cirrhosis with PVT from 2000 to 2020 at our institution. Patients were divided into two groups, those that received PVR‐TIPS due to anticipated surgical challenges from chronic obliterative PVT and those who did not because of partial PVT. Demographic data and long‐term outcomes were compared. A total of 35 patients received PVR‐TIPS while 14 did not, with all receiving LT. Patients with PVR‐TIPS had a higher Yerdel score and frequency of cavernoma than those that did not. PVR‐TIPS was effective in decreasing portosystemic gradient (16 down to 8 mm HG; p < 0.05). Both groups allowed for end‐to‐end anastomoses in >90% of cases. However, veno–veno bypass was used significantly more in patients who did not receive PVR‐TIPS. Additionally, patients without PVR‐TIPS required significantly more intraoperative red blood cells. Overall survival was not different between groups. PVR‐TIPS demonstrated efficacy in resolving PVT and allowed for end‐to‐end portal vein anastomoses. PVR‐TIPS is a viable treatment option for chronic obliterative PVT with or without cavernoma that simplifies the surgical aspects of LT.
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Portal vein thrombosis (PVT) is no longer considered a contraindication for transjugular intrahepatic portosystemic shunt (TIPS). On the other hand, TIPS has shown to improve PVT (1) and reduce the risk of rebleeding as compared with endoscopic band ligation and propranolol albeit without providing a survival benefit (2,3). Also portal vein recanalization and TIPS in cirrhotics with chronic, obliterative PVT has increased the eligibility for liver transplantation and reduced the need for complex surgical grafts during transplantation (4,5).
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Portal vein thrombosis
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Portal vein thrombosis
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Portal vein thrombosis
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Portal vein thrombosis
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