A Case of Liver Transplantation using a Jump Graft in a Patient with Portal Vein Thrombosis and Postoperative Chylous Ascites

ABSTRACT

Venous anomalies, including portal vein thrombosis (PVT) and prior portosystemic shunts, are not uncommon in orthotopic liver transplantation (OLT) and require vascular reconstruction. PVT has been considered as a contraindication to OLT because of surgical complexity and increased postoperative morbidity and mortailty rates. Postoperative chylous ascites occur following disruption of abdominal lymphatics after retroperitoneal dissection. Chyloperitoeum after OLT is very rare. We report a case of piggyback OLT in a cirrhotic patient with portal vein thrombosis. A thromboendarterectomy was attempted first, and a venous jump graft was required between the donor portal vein and the infrapancreatic superior mesenteric vein. An aortic conduit was used for the hepatic arterial reconstruction. Retroperitoneal dissection was inevitable. Chylous ascites developed after the operation and were managed successfully with a low-at diet. In conclusion, we suggest that the presence of PVT is not a contraindication for OLT. Chylous ascites are rare after OLT, and the treatment of choice is a conservative one based on diet control.