-Case Reports-

Interventional Treatment of Severe Portal Vein Thrombosis after Living-Donor Liver Transplantation

Youichi Kawano¹, Satoru Murata², Nobuhiko Taniai¹, Masato Yoshioka¹, Atsushi Hirakata³, Yoshiaki Mizuguchi¹, Tetsuya Shimizu¹, Tomohiro Kanda¹, Junji Ueda¹, Hideyuki Takada¹, Hiroshi Yoshida³, Koho Akimaru¹, Shiro Onozawa², Shinichirou Kumita² and Eiji Uchida¹

¹Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
²Department of Radiology, Nippon Medical School, Tokyo, Japan
³Department of Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan

Portal vein thrombosis (PVT) is a rare complication of liver transplantation which can lead to graft failure and patient death. Treatment can be difficult, especially in cases of PVT from the intrahepatic portal vein to the proximal jejunal veins. A 55-year-old woman had undergone living-donor liver transplantation with splenectomy for end-stage liver cirrhosis due to hepatitis C with hepatocellular carcinoma. Ten months after transplantation, massive ascites and slight abdominal pain developed, and computed tomography revealed a PVT between the intrahepatic portal vein and the superior mesenteric vein. Repeated interventional radiology procedures were used in combination with thrombolysis, thrombectomy, and metallic stent replacement to obtain favorable portal flow to the graft. Five years after being treated, the patient is well, with favorable portal flow having been confirmed. In conclusion, repeated and assiduous interventional radiological treatment combined with thrombolytic therapy, thrombectomy, and metallic stent replacement could be important for severe PVT.

J Nippon Med Sch 2016; 83: 206-210

Keywords
living-donor liver transplantation, portal vein thrombosis, complication, interventional treatment

Correspondence to
Youichi Kawano, MD, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
y-kawano@nms.ac.jp

Received, March 23, 2016
Accepted, September 20, 2016