Multivisceral transplantation for diffuse portomesenteric thrombosis

Rodrigo M. Vianna, Richard Mangus, Chandrashekhar Kubal, Jonathan A. Fridell, Thiago Beduschi, A. Joseph Tector

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Objective: To evaluate the clinical outcomes of multivisceral transplantation (MVT) in the setting of diffuse thrombosis of the portomesenteric venous system. Background: Liver transplantation (LT) in the face of cirrhosis and diffuse portomesenteric thrombosis (PMT) is controversial and contraindicated in many transplant centers. LT using alternative techniques such as portocaval hemitransposition fails to eliminate complications of portal hypertension. MVT replaces the liver and the thrombosed portomesenteric system. Methods: A database of intestinal transplant patients was maintained with prospective analysis of outcomes. The diagnosis of diffuse PMT was established with dual-phase abdominal computed tomography or magnetic resonance imaging with venous reconstruction. Results: Twenty-five patients with grade IV PMT received 25 MVT. Eleven patients underwent simultaneous cadaveric kidney transplantation. Biopsy-proven acute cellular rejection was noted in 5 recipients, which was treated successfully. With a median follow-up of 2.8 years, patient and graft survival were 80%, 72%, and 72% at 1, 3, and 5 years, respectively. To date, all survivors have good graft function without any signs of residual/recurrent features of portal hypertension. Conclusions: MVT can be considered as an option for the treatment of patients with diffuse PMT. MVT is the only procedure that completely reverses portal hypertension and addresses the primary disease while achieving superior survival results in comparison to the alternative options.

Original languageEnglish
Pages (from-to)1144-1150
Number of pages7
JournalAnnals of Surgery
Volume255
Issue number6
DOIs
StatePublished - Jun 2012

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Thrombosis
Transplantation
Portal Hypertension
Liver Transplantation
Transplants
Graft Survival
Venous Thrombosis
Kidney Transplantation
Survivors
Fibrosis
Tomography
Magnetic Resonance Imaging
Databases
Biopsy
Survival
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Vianna, R. M., Mangus, R., Kubal, C., Fridell, J. A., Beduschi, T., & Joseph Tector, A. (2012). Multivisceral transplantation for diffuse portomesenteric thrombosis. Annals of Surgery, 255(6), 1144-1150. https://doi.org/10.1097/SLA.0b013e31825429c0

Multivisceral transplantation for diffuse portomesenteric thrombosis. / Vianna, Rodrigo M.; Mangus, Richard; Kubal, Chandrashekhar; Fridell, Jonathan A.; Beduschi, Thiago; Joseph Tector, A.

In: Annals of Surgery, Vol. 255, No. 6, 06.2012, p. 1144-1150.

Research output: Contribution to journalArticle

Vianna, RM, Mangus, R, Kubal, C, Fridell, JA, Beduschi, T & Joseph Tector, A 2012, 'Multivisceral transplantation for diffuse portomesenteric thrombosis', Annals of Surgery, vol. 255, no. 6, pp. 1144-1150. https://doi.org/10.1097/SLA.0b013e31825429c0
Vianna, Rodrigo M. ; Mangus, Richard ; Kubal, Chandrashekhar ; Fridell, Jonathan A. ; Beduschi, Thiago ; Joseph Tector, A. / Multivisceral transplantation for diffuse portomesenteric thrombosis. In: Annals of Surgery. 2012 ; Vol. 255, No. 6. pp. 1144-1150.
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