Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis

Riad Salem*, Michael Vouche, Talia Baker, Jose Ignacio Herrero, Juan Carlos Caicedo, Jonathan Fryer, Ryan Hickey, Ali Habib, Michael Abecassis, Felicitas Koller, Robert Vogelzang, Kush Desai, Bartley Thornburg, Elias Hohlastos, Scott Resnick, Robert J. Lewandowski, Kent Sato, Robert K. Ryu, Daniel Ganger, Laura Kulik

*Corresponding author for this work

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background.Chronic, obliterative portal vein (PV) thrombosis (PVT) represents a relative contraindication to liver transplantation (LT) in some centers. When PV thromboembolectomy is not feasible, alternative techniques (portacaval hemitransposition, portal arterialization, multivisceral transplantation) are associated with suboptimal outcomes. In cases where a chronically thrombosed PV has become obliterated, we developed PV recanalization (PVR)-transjugular intrahepatic portosystemic shunt (TIPS) to potentiate LT.We evaluated the impact of PVR-TIPS on liver function, transplant eligibility, and long-termoutcomes after LT. Methods. Forty-four patients with chronic obliterative main PVTwere identified during our institutional LTselection committee. After joint imaging review by transplant surgery/radiology, these patients underwent PVR-TIPS to potentiate transplant eligibility. Patients were followed by hepatology/transplant until LT, and ultimately in posttransplant clinic. The TIPS venography and serial ultrasound/MRI were used subsequently to document PV patency. Results. The main PV (MPV) was completely thrombosed in 17 of 44 (39%) patients; near complete (>95%) occlusion was noted in 27 of 44 (61%) patients. Direct transhepatic and transsplenic punctures were required in 11 of 43 (26%) and 3 of 43 (7%) cases, respectively. Technical success was 43 of 44 (98%) cases. At PVRTIPS completion, persistence of MPV thrombus was noted in 33 of 43 (77%) cases. One-month TIPS venography demonstrated complete resolution of MPVthrombosis in 22 of 29 (76%)without anticoagulation. Thirty-six patients were listed for transplantation; 18 (50%) have been transplanted. Eighty-nine percentMPVpatency rate and82%survival were achievedat 5 years. Conclusions.The PVR-TIPS may be considered for patients with obliterative PVTwho are otherwise appropriate candidates for LT. The high rate ofMPV patency post-TIPS placement suggests flow reestablishment as the dominantmechanism of thrombus resolution.

Original languageEnglish (US)
Pages (from-to)2347-2355
Number of pages9
JournalTransplantation
Volume99
Issue number11
DOIs
StatePublished - Oct 23 2015

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Transjugular Intrahepatic Portasystemic Shunt
Portal Vein
Thrombosis
Liver Transplantation
Transplants
Phlebography
Transplantation
Gastroenterology
Punctures
Radiology
Survival Rate
Joints
Liver

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{54f40fb1e28443979703b5023f28ba92,
title = "Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis",
abstract = "Background.Chronic, obliterative portal vein (PV) thrombosis (PVT) represents a relative contraindication to liver transplantation (LT) in some centers. When PV thromboembolectomy is not feasible, alternative techniques (portacaval hemitransposition, portal arterialization, multivisceral transplantation) are associated with suboptimal outcomes. In cases where a chronically thrombosed PV has become obliterated, we developed PV recanalization (PVR)-transjugular intrahepatic portosystemic shunt (TIPS) to potentiate LT.We evaluated the impact of PVR-TIPS on liver function, transplant eligibility, and long-termoutcomes after LT. Methods. Forty-four patients with chronic obliterative main PVTwere identified during our institutional LTselection committee. After joint imaging review by transplant surgery/radiology, these patients underwent PVR-TIPS to potentiate transplant eligibility. Patients were followed by hepatology/transplant until LT, and ultimately in posttransplant clinic. The TIPS venography and serial ultrasound/MRI were used subsequently to document PV patency. Results. The main PV (MPV) was completely thrombosed in 17 of 44 (39{\%}) patients; near complete (>95{\%}) occlusion was noted in 27 of 44 (61{\%}) patients. Direct transhepatic and transsplenic punctures were required in 11 of 43 (26{\%}) and 3 of 43 (7{\%}) cases, respectively. Technical success was 43 of 44 (98{\%}) cases. At PVRTIPS completion, persistence of MPV thrombus was noted in 33 of 43 (77{\%}) cases. One-month TIPS venography demonstrated complete resolution of MPVthrombosis in 22 of 29 (76{\%})without anticoagulation. Thirty-six patients were listed for transplantation; 18 (50{\%}) have been transplanted. Eighty-nine percentMPVpatency rate and82{\%}survival were achievedat 5 years. Conclusions.The PVR-TIPS may be considered for patients with obliterative PVTwho are otherwise appropriate candidates for LT. The high rate ofMPV patency post-TIPS placement suggests flow reestablishment as the dominantmechanism of thrombus resolution.",
author = "Riad Salem and Michael Vouche and Talia Baker and Herrero, {Jose Ignacio} and Caicedo, {Juan Carlos} and Jonathan Fryer and Ryan Hickey and Ali Habib and Michael Abecassis and Felicitas Koller and Robert Vogelzang and Kush Desai and Bartley Thornburg and Elias Hohlastos and Scott Resnick and Lewandowski, {Robert J.} and Kent Sato and Ryu, {Robert K.} and Daniel Ganger and Laura Kulik",
year = "2015",
month = "10",
day = "23",
doi = "10.1097/TP.0000000000000729",
language = "English (US)",
volume = "99",
pages = "2347--2355",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis

AU - Salem, Riad

AU - Vouche, Michael

AU - Baker, Talia

AU - Herrero, Jose Ignacio

AU - Caicedo, Juan Carlos

AU - Fryer, Jonathan

AU - Hickey, Ryan

AU - Habib, Ali

AU - Abecassis, Michael

AU - Koller, Felicitas

AU - Vogelzang, Robert

AU - Desai, Kush

AU - Thornburg, Bartley

AU - Hohlastos, Elias

AU - Resnick, Scott

AU - Lewandowski, Robert J.

AU - Sato, Kent

AU - Ryu, Robert K.

AU - Ganger, Daniel

AU - Kulik, Laura

PY - 2015/10/23

Y1 - 2015/10/23

N2 - Background.Chronic, obliterative portal vein (PV) thrombosis (PVT) represents a relative contraindication to liver transplantation (LT) in some centers. When PV thromboembolectomy is not feasible, alternative techniques (portacaval hemitransposition, portal arterialization, multivisceral transplantation) are associated with suboptimal outcomes. In cases where a chronically thrombosed PV has become obliterated, we developed PV recanalization (PVR)-transjugular intrahepatic portosystemic shunt (TIPS) to potentiate LT.We evaluated the impact of PVR-TIPS on liver function, transplant eligibility, and long-termoutcomes after LT. Methods. Forty-four patients with chronic obliterative main PVTwere identified during our institutional LTselection committee. After joint imaging review by transplant surgery/radiology, these patients underwent PVR-TIPS to potentiate transplant eligibility. Patients were followed by hepatology/transplant until LT, and ultimately in posttransplant clinic. The TIPS venography and serial ultrasound/MRI were used subsequently to document PV patency. Results. The main PV (MPV) was completely thrombosed in 17 of 44 (39%) patients; near complete (>95%) occlusion was noted in 27 of 44 (61%) patients. Direct transhepatic and transsplenic punctures were required in 11 of 43 (26%) and 3 of 43 (7%) cases, respectively. Technical success was 43 of 44 (98%) cases. At PVRTIPS completion, persistence of MPV thrombus was noted in 33 of 43 (77%) cases. One-month TIPS venography demonstrated complete resolution of MPVthrombosis in 22 of 29 (76%)without anticoagulation. Thirty-six patients were listed for transplantation; 18 (50%) have been transplanted. Eighty-nine percentMPVpatency rate and82%survival were achievedat 5 years. Conclusions.The PVR-TIPS may be considered for patients with obliterative PVTwho are otherwise appropriate candidates for LT. The high rate ofMPV patency post-TIPS placement suggests flow reestablishment as the dominantmechanism of thrombus resolution.

AB - Background.Chronic, obliterative portal vein (PV) thrombosis (PVT) represents a relative contraindication to liver transplantation (LT) in some centers. When PV thromboembolectomy is not feasible, alternative techniques (portacaval hemitransposition, portal arterialization, multivisceral transplantation) are associated with suboptimal outcomes. In cases where a chronically thrombosed PV has become obliterated, we developed PV recanalization (PVR)-transjugular intrahepatic portosystemic shunt (TIPS) to potentiate LT.We evaluated the impact of PVR-TIPS on liver function, transplant eligibility, and long-termoutcomes after LT. Methods. Forty-four patients with chronic obliterative main PVTwere identified during our institutional LTselection committee. After joint imaging review by transplant surgery/radiology, these patients underwent PVR-TIPS to potentiate transplant eligibility. Patients were followed by hepatology/transplant until LT, and ultimately in posttransplant clinic. The TIPS venography and serial ultrasound/MRI were used subsequently to document PV patency. Results. The main PV (MPV) was completely thrombosed in 17 of 44 (39%) patients; near complete (>95%) occlusion was noted in 27 of 44 (61%) patients. Direct transhepatic and transsplenic punctures were required in 11 of 43 (26%) and 3 of 43 (7%) cases, respectively. Technical success was 43 of 44 (98%) cases. At PVRTIPS completion, persistence of MPV thrombus was noted in 33 of 43 (77%) cases. One-month TIPS venography demonstrated complete resolution of MPVthrombosis in 22 of 29 (76%)without anticoagulation. Thirty-six patients were listed for transplantation; 18 (50%) have been transplanted. Eighty-nine percentMPVpatency rate and82%survival were achievedat 5 years. Conclusions.The PVR-TIPS may be considered for patients with obliterative PVTwho are otherwise appropriate candidates for LT. The high rate ofMPV patency post-TIPS placement suggests flow reestablishment as the dominantmechanism of thrombus resolution.

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U2 - 10.1097/TP.0000000000000729

DO - 10.1097/TP.0000000000000729

M3 - Article

VL - 99

SP - 2347

EP - 2355

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 11

ER -