Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2020; 26(21): 2691-2701
Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2691
Tailored classification of portal vein thrombosis for liver transplantation: Focus on strategies for portal vein inflow reconstruction
Fei Teng, Ke-Yan Sun, Zhi-Ren Fu
Fei Teng, Ke-Yan Sun, Zhi-Ren Fu, Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
Author contributions: Teng F and Sun KY contributed equally to this paper regarding the conception and design of the study, literature review and analysis, and drafting and editing of the manuscript. Fu ZR made critical revisions and all authors approved the final version.
Supported by the National Natural Science Foundation of China, No. 81702923.
Conflict-of-interest statement: No potential conflicts of interest. No financial support was provided.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Ren Fu, MPhil, Director, Professor, Surgeon, Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, 415 Fengyang Road, Huangpu District, Shanghai 200003, China. zhirenf@smmu.edu.cn
Received: February 17, 2020
Peer-review started: February17, 2020
First decision: March 15, 2020
Revised: March 25, 2020
Accepted: April 22, 2020
Article in press: April 22, 2020
Published online: June 7, 2020

Portal vein thrombosis (PVT) is currently not considered a contraindication for liver transplantation (LT), but diffuse or complicated PVT remains a major surgical challenge. Here, we review the prevalence, natural course and current grading systems of PVT and propose a tailored classification of PVT in the setting of LT. PVT in liver transplant recipients is classified into three types, corresponding to three portal reconstruction strategies: Anatomical, physiological and non-physiological. Type I PVT can be removed via low dissection of the portal vein (PV) or thrombectomy; porto-portal anastomosis is then performed with or without an interposed vascular graft. Physiological reconstruction used for type II PVT includes vascular interposition between mesenteric veins and PV, collateral-PV and splenic vein-PV anastomosis. Non-physiological reconstruction used for type III PVT includes cavoportal hemitransposition, renoportal anastomosis, portal vein arterialization and multivisceral transplantation. All portal reconstruction techniques were reviewed. This tailored classification system stratifies PVT patients by surgical complexity, risk of postoperative complications and long-term survival. We advocate using the tailored classification for PVT grading before LT, which will urge transplant surgeons to make a better preoperative planning and pay more attention to all potential strategies for portal reconstruction. Further verification in a large-sample cohort study is needed.

Keywords: Portal vein thrombosis, Liver transplantation, Portal reconstruction, Grading, Anatomical, Physiological, Non-physiological

Core tip: In the tailored classification for liver transplantation, portal vein thrombosis (PVT) is divided into types I, II and III according to the vascular sources used for portal reconstruction. The proposed algorithm for the tailored PVT classification and PV reconstruction strategy contributes to stratification of PVT patients by surgical complexity, risk of postoperative complications and long-term survival.