Risk Factors Analysis And Diagnosis And Treatment Of Early Complications Of Portal Vein After Liver Transplantation

ObjectiveWith the improvement of surgical technology,the expansion of donor sources,and the application of postoperative immune drugs,liver transplantation has become an effective method for the treatment of a variety of end-stage liver diseases.The indications include liver cirrhosis caused by various reasons,hepatocellular carcinoma or other primary/secondary liver tumors which meets surgical standards,liver failure after ineffective medical treatment,congenital metabolic disease,non-alcoholic fatty liver disease,autoimmune liver disease,polycystic liver,etc.Complications of the vascular or biliary tract,acute or chronic rejection reaction,viral infection,tumor metastasis and recurrence all affect the efficacy and prognosis of liver transplantation.The unique vascular anatomy of the liver increases the difficulty of liver transplantation.In addition to the anastomosis of the inflow(hepatic artery)and outflow channels(hepatic vein,inferior vena cava)that similar to other organ transplantations,there is also another anastomosis of the portal vein system,increasing the occurrence of portal vein complications at the same time.Because of the speciality of the liver portal vein system,portal vein complications can affect liver blood flow and physiological functions in the early postoperative period.In severe cases,complications such as liver failure and portal hypertension can cause graft loss and even patient death.Therefore,this article intends to retrospectively analyze the clinical data of adult orthotopic liver transplantation patients in our center from January 2016 to December 2018,and try to summarize the risk factors and diagnosis and treatment experience of early complications of portal vein after liver transplantation for better prevention during the operation,to provide reference for the diagnosis and treatment of similar patients and improve the prognosis.Materials&Methods1.Medical records of 616 patients who underwent liver transplantation at the Organ Transplantation Center of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2018 were collected,and divide them into complications group and non-complication group according to whether early postoperative portal vein complications occurred.Relevant clinical indicators of the two groups were collected;2.We put clinical indicators in the χ2 test and observe whether the differences in the composition of clinical indicators between the two groups are statistically significant;3.Incorporate clinical indicators into monovariate logistic regression for analysis of influencing factors,and derive risk factors for early portal vein complications after liver transplantation;4.Put the above-mentioned single-factor logistic regression risk factors into multi-factor logistic regression,and analysis of independent risk factors for early portal vein complications after liver transplantation;5.The diagnosis and treatment process and related clinical data of patients in the complication group were organized.Results1.The χ2 test results showed that there were no statistical significant differences in the recipients’ age,gender,operation time,anhepatic period time,cold ischemia time,whether the donor and recipient blood types were consistent,intraoperative blood loss volume,and intraoperative red blood cell transfusion between two groups(P>0.05)2.Univariate logistic analysis showed that preoperative recipients had portal vein thrombosis(P<0.001,odds ratio 0.034,95%confidence interval 0.008～0.138),operative history of splenectomy(P<0.001,odds ratio 27.765,95%confidence interval).6.844～112.637),methods of portal vein anastomosis(P<0.001,odds ratio 34.4,95%confidence interval 5.68～208.350)and re-transplantation(P<0.001,odds ratio 34.400,95%confidence interval 5.680～208.350)are risk factors of early portal vein complications,while age,gender,operation time,cold ischemia time,whether the donor and recipient blood types are consistent,anhepatic period time,intraoperative blood loss volume,and intraoperative red blood cell transfusion have nothing to do with early portal vein complications(P>0.05).3.The risk factors related to early portal vein complications in monovariate analysis were included in the binary logistic regression analysis,and the results showed that the recipient had preoperative portal vein thrombosis(P=0.012,odds ratio=16.922,95%confidence interval 1.859～154.059)and re-transplantation(P<0.001,odds ratio=64.871,95%confidence interval 8.293～507.435)are independent risk factors for early portal vein complications.4.There were 9 patients with early portal vein complications,including 6 patients with portal vein thrombosis,1 with stenosis,2 with abnormal blood flow(slow flow rate,bidirectional blood flow,or no blood flow)accompanied no thrombus or stenosis.All of the patients were confirmed by color doppler ultrasound and/or CT angiography.Three patients with normal liver function and portal vein thrombosis received oral thrombolytic therapy.Three patients with abnormal liver function and portal vein thrombosis received surgical thrombectomy and implantation via the omentum portal vein pump,Portal blood flow was smooth for follow-up 22 ± 14.8 months.One patient with portal vein stenosis underwent portal vein balloon dilatation and stent implantation,and portal vein blood flow was smooth followed for 17 months.Two patients with abnormal blood flow apart from thrombosis and stenosis were both liver re-transplantation.One patient underwent surgical exploration to ligate the shunt vessels and died of multiple organ failure after this operation.One patient was diagnosed as the seventh-day syndrome,and died while waiting for another liver transplantation.Conclusions1.Recipients with portal vein thrombosis,history of splenectomy,unusual portal vein anastomosis,and re-transplantation are risk factors for early portal vein complications;2.Preoperative presence of portal vein thrombosis and re-transplantation of the recipient are independent risk factors for early portal vein complications;3.Targeted treatment of different types of portal vein complications after adult liver transplantation can achieve good results.