Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and...Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and use of sizable collaterals(pericholedochal varix[8,9],coronary vein,peripancreatic or perigastroesophageal varices[10],right superior colic vein[11],ileocolic vein[12],and left gastric vein[13]),or combined liverpancreas-small bowel transplant[14]are required for portal inflow in patients with total portosplenomesenteric thrombosis.展开更多
BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidenc...BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its in-cidence. METHODS: We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131). RESULTS: The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS. CONCLUSIONS: Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.展开更多
文摘Portal vein thrombosis(PVT)is no longer a definitive contraindication in liver transplants(LTs)[1].Complex vascular reconstructions such as cavoportal hemitransposition(CPHT)[2–5],renoportal anastomosis(RPA)[6,7],and use of sizable collaterals(pericholedochal varix[8,9],coronary vein,peripancreatic or perigastroesophageal varices[10],right superior colic vein[11],ileocolic vein[12],and left gastric vein[13]),or combined liverpancreas-small bowel transplant[14]are required for portal inflow in patients with total portosplenomesenteric thrombosis.
文摘BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its in-cidence. METHODS: We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131). RESULTS: The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS. CONCLUSIONS: Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.
