ADULT LIVER-TRANSPLANTATION AND ABNORMALITIES OF SPLANCHNIC VEINS - EXPERIENCE IN 53 PATIENTS

The aim of this study was to analyze the influence of technical proble ms resulting from splanchnic venous anomalies on the outcome of orthot opic liver transplantation. From February 1984 until December 1995, 53 (16.3 %) of 326 adults underwent consecutive transplantations whilst having acquired anomalies of the splanchnic veins. These consisted of portal vein thrombosis (n = 32, 9.8 %), thrombosis with inflammatory v enous changes (phlebitis; n = 6, 1.8 %) and alterations related to por tal hypertension surgery (n = 15, 4.6 %). Because of major changes in surgical technique, i, e., eversion instead of blind venous thrombecto my, immediate superior mesenteric vein approach in cases of extended t hrombosis, and piggyback implantation with preservation instead of rem oval of the inferior vena cava, patients were divided into two groups: those who underwent transplantation during the period February 1984 t o December 1990 (group 1) and those transplanted between January 1991 and December 1995 (group 2), Surgical procedures to overcome the anoma lies consisted of venous thrombectomy (n = 26), implantation of the do nor portal vein at the splenomesenteric confluence (n = 5) or onto a s plenic (n = 1) or ileal varix (n = 1), interposition of a free iliac v enous graft between recipient superior mesenteric vein and donor porta l vein (n = 9,) and interruption of surgical portosystemic shunt (n = 13). All patients had a complete follow-up. The 1- and 5-year actuaria l patient survival rates were similar in patients with (n = 53) and wi thout (n = 273) splanchnic venous abnormalities (75.5 % vs 78,1 % and 64.3 % vs 66.9 %, respectively), Early (< 3 months) post-transplant mo rtality was 24.5 % (13/53 patients). Mortality was highest in the port al vein thrombophlebitis group (5/6, 83.3 %), followed by the portal h ypertension surgery group (5/15, 33.3 %) and the portal vein thrombosi s group (3/32, 9.4 %). Technical modifications significantly reduced m ortality in group 2 (10.3 %. 3/29 vs 41.7 %. 10/24 patients in group 1 ; P < 0.05) as well as the need for re-exploration for bleeding (13.8 %. 4/29 patients in group 2 vs 15/24, 62.5 % in group 1; P < 0.01). Mo rtality directly related to bleeding was also significantly lowered (1 /29, 3.4 % in group 2 vs 9/ 24, 37.5 % in group 1, P < 0.01). We concl ude that liver transplantation can be safely performed in the presence of splanchnic vein thrombosis and previous portal hypertension surger y.