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Vol. 69. Núm. 4.
Páginas 340-345 (abril 2001)
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Vol. 69. Núm. 4.
Páginas 340-345 (abril 2001)
Acceso a texto completo
Trombosis portal pre y postrasplante hepático: incidencia, tratamiento y evolución tras 500 trasplantes
Portal vein thrombosis before and after liver transplantation: incidence, treatment and evolution in 500 transplantations
Visitas
8545
J. Torras1, L. Lladó, J. Figueras, E. Ramos, C. Lama, A. Rafecas, J. Fabregat, J. Busquets, L. Ibáñez, E. Jaurrieta
Servicios de Cirugía General y Digestiva
J. Domínguez*
* Angiorradiología. Unidad de Trasplante hepático. Ciudad Sanitaria y Universitaria de Bellvitge. L’Hospitalet de Llobregat. Barcelona.
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Bibliografía
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Resumen
Introducción

Los objetivos de este estudio son establecer la incidencia y tipo de trombosis portal (TP), así como analizar el tratamiento y evolución de cada tipo de trombosis en 500 trasplantes hepáticos (TH) consecutivos.

Material y métodos

Desde 1984 hasta enero de 1999 nuestro grupo ha realizado 500 TH en 435 pacientes. Estudiamos de forma retrospectiva a todos aquellos pacientes con diagnóstico de trombosis portal pre-TH. Asimismo, se estudian todos aquellos pacientes con el diagnóstico de TP post-TH precoz (primeros 30 días post-TH) y TP tardías si el diagnóstico es posterior.

Resultados

Trombosis portal pretrasplante. Su incidencia fue del 6,2% (31 casos), siendo la mitad completas. La mayoría de TP parciales (12 de 16 casos) se solucionaron mediante anastomosis portal terminoterminal. No hubo ningún caso de TP post-TH. En la mayoría de casos con TP completa (11 de 15) el flujo portal se restableció mediante un injerto venoso mesoportal extraanatómico. La incidencia de TP post-TH fue del 6,6% (un caso).

La incidencia global de trombosis portal postrasplante precoz fue del 1,8% (9 casos). El 44% precisaron retrasplante y la mortalidad asociada fue del 22%. La incidencia de TP post-TH tardía fue del 1,4% (7 casos) con una media de diagnóstico de 22,3 (rango: 2-78) meses; sólo 3 casos presentaron clínica, en forma de ascitis; dos fueron tratados con éxito mediante angioplastia con colocación de prótesis portal. La mortalidad asociada a esta complicación fue nula.

Conclusiones

La TP pre-TH no es actualmente una contraindicación para el trasplante. Consideramos el injerto venoso mesoportal como técnica de elección cuando la TP pre-TH es completa. La trombectomía y revascularización urgente es el tratamiento de elección en los casos de TP post-TH precoz. La mortalidad del retrasplante por esta complicación es alta. Los casos de TP post-TH tardía en adultos que cursan con hipertensión portal sintomática pueden beneficiarse de técnicas de radiología intervencionista como la angioplastia y la prótesis portal.

Palabras clave:
Trombosis portal
Trasplante hepático
Injerto venoso mesoportal
Introduction

The aims of the present study were to determine the incidence and type of portal vein thrombosis (PVT) in 500 consecutive liver transplantations as well as to analyze the treatment and evolution of each type of thrombosis.

Material and methods

From 1984 to January 1999 we carried out 500 liver transplantations in 435 patients. We retrospectively studied all patients with a pre-transplantation diagnosis of PVT. We also studied all patients with a post-transplantation diagnosis of early (first 30 days after liver transplantation) and late (31 days or more after transplantation) PVT.

Results

The incidence of pre-transplantation PVT was 6.2% (31 patients), half of which were complete. The majority of partial PVTs (12/16) were resolved by portal termino-terminal anastomosis. Of these 16 patients none developed posttransplantation portal thrombosis. In most patients with complete portal thrombosis (11/15) portal flow was reestablished through an extra-anatomic mesoportal venous graft. The incidence of post-transplantation PVT was 6.6% (1 patient). The overall incidence of early post-transplantation PVT was 1.8% (9 patients). Forty-four percent required retransplantation and associated mortality was 22%. The incidence of late posttransplantation PVT was 1.4% (7 patients). Diagnosis was at a mean of 22.3 (2-78) months. Symptomatology in the form of ascites was present in only 3 patients. Two patients were successfully treated by angioplasty with implantation of portal prosthesis. Mortality associated with this complication was nil.

Conclusions

Pre-transplantation PVT does not currently contraindicate transplantation. We consider extra-anatomic mesoportal venous graft to be the technique of choice in pretransplantation complete PVT. Thrombectomy and urgent revascularization is the treatment of choice in early post-transplantation PVT. Mortality after retransplantation due to this complication is high. Late post-transplantation PVT in adults with symptomatic portal hypertension may benefit from interventionist radiological techniques such as angioplasty and portal prosthesis.

Key words:
Portal thrombosis
Liver transplantation
Extra-anatomic mesoportal venous graft
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Copyright © 2001. Asociación Española de Cirujanos
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