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Portal vein thrombosis and liver transplantation: management, matching, and outcomes. A retrospective multicenter cohort study.
Di Benedetto, Fabrizio; Magistri, Paolo; Di Sandro, Stefano; Boetto, Riccardo; Tandoi, Francesco; Camagni, Stefania; Lauterio, Andrea; Pagano, Duilio; Nicolini, Daniele; Violi, Paola; Dondossola, Daniele; Guglielmo, Nicola; Cherchi, Vittorio; Lai, Quirino; Toti, Luca; Bongini, Marco; Frassoni, Samuele; Bagnardi, Vincenzo; Mazzaferro, Vincenzo; Tisone, Giuseppe; Rossi, Massimo; Baccarani, Umberto; Ettorre, Giuseppe Maria; Caccamo, Lucio; Carraro, Amedeo; Vivarelli, Marco; Gruttadauria, Salvatore; De Carlis, Luciano; Colledan, Michele; Romagnoli, Renato; Cillo, Umberto.
Afiliación
  • Di Benedetto F; Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena.
  • Magistri P; Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena.
  • Di Sandro S; Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena.
  • Boetto R; Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova.
  • Tandoi F; Liver Transplant Unit, General Surgery 2U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin.
  • Camagni S; Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo.
  • Lauterio A; General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, Milan.
  • Pagano D; University of Milano-Bicocca.
  • Nicolini D; IRCCS-ISMETT-UPMCI, Palermo.
  • Violi P; Hepatobiliary, Pancreatic and Transplantation Surgery, Dept. of Experimental and Clinical Medicine, Polytechnic University of Marche.
  • Dondossola D; Department of General Surgery and Dentistry, Liver Transplant Unit, University Hospital of Verona, Verona.
  • Guglielmo N; Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi, Milan.
  • Cherchi V; Department of General Surgery and Transplantation, San Camillo-Forlanini General Hospital, Rome.
  • Lai Q; Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, Udine.
  • Toti L; Department of General Surgery and Organ Transplantation, Sapienza University.
  • Bongini M; Department of Surgery Science, Transplant and HPB Unit, University of Rome Tor Vergata, Rome.
  • Frassoni S; Department of Oncology and Hemato-Oncology, University of MilanHepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano.
  • Bagnardi V; Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan.
  • Mazzaferro V; Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan.
  • Tisone G; Department of Oncology and Hemato-Oncology, University of MilanHepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano.
  • Rossi M; Department of Surgery Science, Transplant and HPB Unit, University of Rome Tor Vergata, Rome.
  • Baccarani U; Department of General Surgery and Organ Transplantation, Sapienza University.
  • Ettorre GM; Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, Udine.
  • Caccamo L; Department of General Surgery and Transplantation, San Camillo-Forlanini General Hospital, Rome.
  • Carraro A; Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi, Milan.
  • Vivarelli M; Department of General Surgery and Dentistry, Liver Transplant Unit, University Hospital of Verona, Verona.
  • Gruttadauria S; Hepatobiliary, Pancreatic and Transplantation Surgery, Dept. of Experimental and Clinical Medicine, Polytechnic University of Marche.
  • De Carlis L; IRCCS-ISMETT-UPMCI, Palermo.
  • Colledan M; University of Catania, Catania, Italy.
  • Romagnoli R; General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, Milan.
  • Cillo U; University of Milano-Bicocca.
Int J Surg ; 110(5): 2874-2882, 2024 May 01.
Article en En | MEDLINE | ID: mdl-38445440
ABSTRACT
BACKGROUND AND

AIMS:

Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients.

METHODS:

Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant.

RESULTS:

Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT ( P <0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present.

CONCLUSIONS:

Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3-4.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vena Porta / Trasplante de Hígado / Trombosis de la Vena Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Int J Surg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vena Porta / Trasplante de Hígado / Trombosis de la Vena Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Int J Surg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos