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Tailored classification of portal vein thrombosis for liver transplantation:Focus on strategies for portal vein inflow reconstruction

查看全文 作　　者：Fei [1]Teng;Ke-Yan [1]Sun;Zhi-Ren [1]Fu 高影响力作者 机构地区：[1]Department of Liver Surgery and Organ Transplantation,Changzheng Hospital,Navy Medical University,Shanghai 200003,China高影响力机构 出　　处：《World Journal of Gastroenterology》索引2020年第26卷第21期,共11页高影响力期刊 基　　金：Supported by the National Natural Science Foundation of China,No.81702923. 摘　　要：Portal vein thrombosis(PVT)is currently not considered a contraindication for liver transplantation(LT),but diffuse or complicated PVT remains a major surgical challenge.Here,we review the prevalence,natural course and current grading systems of PVT and propose a tailored classification of PVT in the setting of LT.PVT in liver transplant recipients is classified into three types,corresponding to three portal reconstruction strategies:Anatomical,physiological and non-physiological.Type I PVT can be removed via low dissection of the portal vein(PV)or thrombectomy;porto-portal anastomosis is then performed with or without an interposed vascular graft.Physiological reconstruction used for type II PVT includes vascular interposition between mesenteric veins and PV,collateral-PV and splenic vein-PV anastomosis.Non-physiological reconstruction used for type III PVT includes cavoportal hemitransposition,renoportal anastomosis,portal vein arterialization and multivisceral transplantation.All portal reconstruction techniques were reviewed.This tailored classification system stratifies PVT patients by surgical complexity,risk of postoperative complications and long-term survival.We advocate using the tailored classification for PVT grading before LT,which will urge transplant surgeons to make a better preoperative planning and pay more attention to all potential strategies for portal reconstruction.Further verification in a large-sample cohort study is needed. 关 键 词：Portal vein thrombosis Liver transplantation Portal reconstruction GRADING ANATOMICAL PHYSIOLOGICAL Non-physiological
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