312.4: Surgical Management of Portal Venous Thrombosis in Patients Undergoing Liver Transplantation Proposed of an Algorithm

Introduction: Portal vein thrombosis (PVT) is common in patients with liver cirrhosis, undergoing liver transplantation (LT); In our environment, this is the first publication with an emphasis on results and surgical strategies.Objectives: It was to review the casuistry of the Guillermo Almenara Irigoyen National Hospital, determine characteristics, types of PVT and surgical management. Materials and Methods: The medical records of cirrhotic patients undergoing LT who presented PVT between March 2000 and June 2021 were analyzed. During this period, 304 liver transplants were performed in 285 patients, 256 adults and 29 pediatric patients; the latter were excluded. Results: We found 46 patients with PVT (17.9%), diagnosed before and during LT, none of malignant aetiology; The most frequent etiologies of cirrhosis were non-alcoholic steatohepatitis (37.4%), alcoholic steatohepatitis (22%), autoimmune hepatitis (AIH) (11%), hepatitis B virus (HBV) (7.4%) and others (11.5%). According to the Yerdel Classification, we find: Grade I: 22 (48%), Grade II: 15 (32.5%), Grade III: 6 (13%) and Grade IV: 3 (6.5%). The surgical strategies used were: thrombectomy in 40 (87.1%); Cavoportal hemitransposition in 2 (4.3%), reno-portal anastomosis with vein graft interposition in 2 (4.3%) and thrombovenectomy plus vein graft interposition in 2 (4.3%). In 3 cases there were re-PVTs (6.5%). We observed that PVT decreased patient survival after LT: One year (81.2%), 3 years (78.4%) and 5 years (78.4%) compared to patients without PVT at 1 year (84.6%) 3 years (82.3%) and 5 years (82.3%). Conclusion: Cirrhotic patients with PVT were clinically more decompensated, survival decreased with a higher degree of PVT. Surgical conduct was similar to other transplant centers; early diagnosis was essential to take an early surgical approach and reduce morbidity and mortality after liver transplantation. A management algorithm for portal vein thrombosis before liver transplantation is proposed. Key words: Portal Vein Thrombosis, Liver Transplantation, Yerdel Classification, Surgical Strategy.