Abstract:Objective:To investigate the application of temporary cavoportal hemitransposition (TCPHT) during conventional orthotopic liver transplant (OLT) in patients with portal vein thrombus (PVT) .
Methods :A group of eleven patients who underwent TCPHT (TCPHT group) was compared with another group of twenty-one patients without TCPHT (control group) among thirty-two adult OLT recipients with PVT of Yerdel′ Ⅲor Ⅳ degree during the recent 5 years. Duration of operation and anhepatic phase, and urinary production in anhepatic and reperfusion phase, and parameters of systemic hemodynamics such as mean artrial blood pressure(MAP), central venous pressure(CVP) and pulmonary arterial wedge pressure(PAWP) were comparatively analysed by case-control study.
Results:No difference in surgical duration and anhepatic time (P>0.05) was found between two groups. There was no significant difference of renal function parameters between the 2 groups at the first day post-transplantation, but the TCPHT group had an improved mean urinary output during anhepatic phase ［(64.09±20.79)mL vs (25.90±12.17)mL, P=0.033］; overall urinary production after reperfusion of TCPHT group and controls was (1 254.56±311.81)mL and (800.00±375.83)mL respectively (P=0.002); cases requiring hemodialysis in TCPHT group decreased markedly (P=0.032). Systemic hemodynamics between TCHHT and control group showed MAP after reperfusion (76.45±12.67) mmHg vs (66.52±7.48)mmHg (P=0.032), CVP(13.96±1.74)cm H2O vs (12.44±1.07)cm H2O(P=0.005), and PAWP(24.04±1.48) mmHg vs (22.81±1.23)mmHg (P=0.018), respectively.
Conclusions:The results suggests that TCPHT is a reliable surgical technique in OLT patients with HVT. This surgical strategy could effectively stabilize systemic hemodynamics and decrease the rate of postoperative renal failure,and without increase in the difficulty of operation.