Intraoperative Endovascular Treatment Via the Ligamentum Teres Hepatis in Liver Transplantation for Yerdel Grade Ⅲ/IV Portal Vein Thrombosis: A Safe and Effective Strategy

N/ACompletedNCT07192653

Chiyi Chen75 enrolled

Overview

Background: To evaluate the safety and efficacy of intraoperative endovascular treatment (EVT) using the donor ligamentum teres hepatis (LTH) approach for Yerdel grade III/IV portal vein thrombosis (PVT) during liver transplantation (LT), a condition that poses a major challenge in complex surgeries. Methods: This single-center retrospective cohort study included some patients with grade III/IV PVT who underwent LT and were divided into two periods: in both periods, patients underwent modified eversion thrombectomy. However, in Period 1 (2016-2019), nonanatomical anastomosis was performed if portal flow was insufficient, and in Period 2 (2019-2024), patients with persistent hypoperfusion underwent additional LTH-based EVT (stenting or shunt occlusion). Perioperative outcomes (operative time, anhepatic phase, and anastomosis type) and long-term outcomes (graft survival and complication rates) were compared between groups.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Liver Transplantation Endovascular Treatment

Interventions

nonanatomical anastomosis

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients (aged ≥18 years). * Patients underwent deceased-donor liver transplantation. * At Tianjin First Central Hospital between February 2016 and December 2024. * Identified recipients with Yerdel grade III/IV PVT, which was confirmed by multiphase contrast-enhanced CT, indirect portography, and intraoperative evaluation Exclusion Criteria: * Exclusion criteria were living-donor and split-liver procedures. * All procedures were performed using classic orthotopic transplantations.

Outcomes

Primary Outcomes

Operative Time

Operative time refers to the duration from the initial surgical incision to the completion of skin closure.

Time frame: Intraoperative

Anhepatic Phase Time

The anhepatic phase time is the critical period during liver transplant surgery when the patient's native liver has been removed and the donor liver has not yet been reperfused.

Time frame: Intraoperative

Rate of Nonanatomical Reconstruction

The rate of nonanatomical resection refers to the frequency with which a surgical procedure removes a tumor without following the boundaries of the organ's functional anatomical units.

Time frame: Intraoperative

Delayed Graft Function

Delayed graft function is a common complication following kidney transplantation where the transplanted organ does not function immediately, often necessitating dialysis within the first week post-surgery.

Time frame: Within 7 days postoperatively

Portal Vein Complications

Portal vein complications are a serious concern in liver transplantation, encompassing issues such as thrombosis, stenosis, and occlusion that can threaten graft survival and patient life.

Time frame: From the surgery to the last follow-up (median follow-up 28 months)

Graft Survival

Graft survival refers to the continued functional existence of a transplanted organ or tissue within a recipient's body.

Time frame: 1-year and 3-year postoperatively