Successful Living-Donor Liver Transplantation With Intraoperative Endovascular Recanalization via Transsplenic Access in a Recipient With Grade III Portal Vein Thrombosis: A Case Report

• Published in: Transplantation proceedings 2019-11, Vol.51 (9), p.3111-3115
• Main Authors: Alshahrani, Abdulwahab Ali, Yoon, Young-In, Moon, Deok-Bog, Ko, Gi-Young, Jung, Dong-Hwan, Park, Gil-Chun, Lee, Sung-Gyu
• Format: Article
• Language: English
• Subjects: Endovascular Procedures - methods; Humans; Liver - blood supply; Liver Transplantation - methods; Living Donors; Male; Middle Aged; Portal Vein - surgery; Splenic Vein - surgery; Venous Thrombosis - complications; Venous Thrombosis - surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2019.08.001

Extensive portosplenomesenteric thrombosis is regarded as a relative contraindication to liver transplantation because of the complexity of the surgical procedure. This report describes a case of living-donor liver transplantation (LDLT) for a patient with extensive portosplenomesenteric thrombosis, in whom portal flow was successfully restored by intraoperative transplenic portal vein and superior mesenteric vein stenting after surgical thrombectomy. The patient’s liver function remained normal with a patent portal vein stent 6 months after LDLT, and Doppler ultrasonography demonstrated a normal wave form for portal flow. To the best of our knowledge, this is the world’s first case of endovascular management of the portal vein via percutaneous transsplenic access during LDLT, demonstrating that transsplenic access can be an alternative approach without liver graft injury when the superior mesenteric vein branch and inferior mesenteric vein cannot be used as access routes. •Extensive portal vein thrombosis (PVT) is regarded as a relative contraindication to liver transplantation (LT) because the complexity of the technique and the morbidities that might follow the procedure.•Living-donor liver transplantation (LDLT) for patients with PVT poses an additional challenge and risks, which require careful operative planning, compared with deceased-donor LT.•Intraoperative portography (IOP) during LDLT is a useful modality for diagnosing and managing the remnant PVT and stenosis related to chronic organized thrombus.•The percutaneous transsplenic approach is another way of IOP to access the portal venous system.