Rodrigues PD, Lazzarotto-da-Silva G, Feier FH, Grezzana Filho TJM, Kruel CRP, Leipnitz I, Chedid MF. Non-tumoral portal vein thrombosis in liver transplantation: Surgical perspectives and institutional protocol. World J Gastrointest Surg 2025; 17(8): 107941 [DOI: 10.4240/wjgs.v17.i8.107941]
Corresponding Author of This Article
Marcio Fernandes Chedid, MD, PhD, Professor, Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre 90035-007, Brazil. mchedid@hcpa.edu.br
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Gastrointest Surg. Aug 27, 2025; 17(8): 107941 Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.107941
Non-tumoral portal vein thrombosis in liver transplantation: Surgical perspectives and institutional protocol
Pablo Duarte Rodrigues, Gabriel Lazzarotto-da-Silva, Flávia Heinz Feier, Tomaz J M Grezzana Filho, Cleber Rosito Pinto Kruel, Ian Leipnitz, Marcio Fernandes Chedid
Pablo Duarte Rodrigues, Gabriel Lazzarotto-da-Silva, Flávia Heinz Feier, Tomaz J M Grezzana Filho, Cleber Rosito Pinto Kruel, Ian Leipnitz, Marcio Fernandes Chedid, Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Brazil
Author contributions: Rodrigues PD participated in the research design, data collection, data analysis, and writing of the manuscript; Lazzarotto-da-Silva G, Feier FH, Grezzana Filho TJM, Kruel CRP, Leipnitz I, and Chedid MF participated in the research design, supervision, and revision of the final manuscript; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marcio Fernandes Chedid, MD, PhD, Professor, Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre 90035-007, Brazil. mchedid@hcpa.edu.br
Received: April 2, 2025 Revised: May 8, 2025 Accepted: July 7, 2025 Published online: August 27, 2025 Processing time: 146 Days and 23.6 Hours
Abstract
Non-tumoral portal vein thrombosis (PVT) is a frequent and challenging complication in liver transplant candidates. The prevalence reaches up to 26% in patients with cirrhosis on a transplant waiting list. Its severity increases with liver disease progression and significantly impacts post-transplant outcomes. Advanced PVT increases postoperative mortality to 30%. Effective management requires a multidisciplinary approach, especially in advanced cases. Preoperative strategies emphasize anticoagulation with low molecular weight heparin, while interventional radiology, including transjugular intrahepatic portosystemic shunts, offers alternatives in some cases. Intraoperatively, management is guided by PVT classification systems, ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases. This manuscript explores the management of PVT in liver transplantation candidates, discusses strategies to optimize outcomes, and presents our institutional protocol for addressing this high-risk condition.
Core Tip: Non-tumoral portal vein thrombosis (PVT) is a common but serious challenge in liver transplant candidates. It significantly affects postoperative outcomes, especially in advanced cases. A multidisciplinary approach is crucial for the management of PVT. Integrating anticoagulation, interventional radiology, and intraoperative strategies that are tailored to PVT severity is paramount. While early PVT cases can be managed with thrombectomy and portal vein reconstruction, complex cases may require alternative surgical techniques. This manuscript provides a comprehensive analysis of PVT management in patients requiring liver transplant by emphasizing evidence-based strategies and presenting our institutional protocol to optimize outcomes in this high-risk population.
