2013 - ISBTS 2013 Symposium
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Posters and Exhibition
15.21 - Multivisceral Transplantation after Unsuccessful Liver Transplantation for Portomesenteric Thrombosis. A report of two cases.
Presenter: Markus, Gabel, , Sweden
Authors: Markus Gabel1, Asa Noren1, Mihai Oltean1, Michael Olausson1, Gustaf Herlenius1
Multivisceral Transplantation after Unsuccessful Liver Transplantation for Portomesenteric Thrombosis. A report of two cases.
Markus Gabel1, Asa Noren1, Mihai Oltean1, Michael Olausson1, Gustaf Herlenius1
1The Transplant Institute, Sahlgrenska University Hospital, Göteborg, Sweden
Liver transplantation (LT) in patients with portomesenteric thrombosis (PMT) is technically challenging and associated with inferior survival when compared to patients with a patent portal vein. We report 2 cases where multivisceral transplantation was performed after unsuccessful LT for PMT.
Case 1: A 48-year-old male with PMT and several episodes of life-threatening variceal bleeding underwent LT at another institution. Adequate portal flow could not be obtained and the patient continued to have life-threatening variceal bleeding and developed massive ascites. He was referred to our center and received a MV graft from a 56-year old donor 2 months after the initial LT. Initial biopsies from the intestinal allograft showed severe ischemia-reperfusion injury. The patient is currently alive 52 months after the MVT but he still requires intravenous supplementation because of high stomal output.
Case 2: A 44-year old female with PMT after a neonatal septicemia. A Sugiura’s procedure was performed at age 3. She developed biliary outflow obstruction, dilated intrahepatic bile ducts and recurring cholangitis. Her nutritional status was poor with BMI 15. She underwent a LT witha venous jump graft to a dilated mesenteric collateral vein. A venous thrombosis of the venous jump graft resulted in critical intestinal ischemia and her small intestine was removed on day 3. A suitable 40-year old donor was available and she underwent MVT on day 4 after the LT. She developed leakage from the gastro-gastric anastomosis that could not be managed because of her extremely catabolic state and she deteriorated and died 42 days after the MVT.
Discussion: MVT as rescue after unsuccessful LT for PMT is possible but requires careful recipient and donor selection.
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