Prevention and treatment of rethrombosis with an implantable pump of the portal vein after liver transplantation / 中华肝胆外科杂志

ABSTRACT

Objective To study the feasibility and efficacy of prevention and treatment of rethrombosis with an implantable pump of the portal veinafter liver transplantation.Methods The clinical data of adult patients who underwent orthotopic liver transplantation from Feb.1999 to Dec.2007 were analyzed retrospectively.Results The 404 orthotopic liver transplantation (LT) patients were divided into three groupsPVT patients with an implantable pump (PVT + implantable pump,n =28),PVT patients without an implantable pump (PVT,n =20),and patients without pre-existing PVT (non-PVT,n =356).The following parameters in the 3 groups of patients were compared(1) pre-operative parameters including baseline data of the donors,recipients,and duration of graft ischemia;(2) intra-operative and postoperative parameters including operative time,red blood cell and plasma transfusion,platelet concentrate transfusion,amount of bleeding,primary graft malfunction,and durations of hospitalization and intensive care unit (ICU) stay;and (3) follow-up data on patency of portal vein,rethrombosis rate,stenosis and reoperation (relaparotomy or retransplantation),in-hospital mortality,and actuarial one-year survival rate.Results among the 3 groups of recipients,there were no significant differences detected in the pre-operative and intra-operative parameters.However,when compared to PVT patients without an implantable pump,PVT patients with an implantable pump showed a remarkable reduction (P ＜ 0.05) in post-operative hospital stay [(21.7 ±8.9) vs.(26.5 ± 6.1)],rethrombosis rate (7.14％ vs.30％),reoperation rate (0 vs.25％),and in-hospital mortality (3.57％ vs.25％).Conclusions Patients with pre-existing PVT had a higher risk of rethrombosis following liver transplantation which was significantly prevented and/or treated with an implantable pump.Implantable pump placement should be considered for PVT patients undergoing liver transplantation.