This report demonstrates modifications in cavo-portal hemi-transposition for liver transplantation, suggesting feasibility for adults with thrombosis.
Extensive porto-mesenteric thrombosis presents a significant challenge in liver transplantation and was previously considered a contraindication. However, advancements in surgical techniques have made liver transplantation feasible. For optimal allograft function, adequate portal flow is crucial, as it generates shear stress that stimulates regeneration. In such cases, portal inflow options include the left renal vein (reno-portal anastomosis; RPA), the inferior vena cava (cavo-portal hemi-transposition; CPHT), any patent splanchnic territory, portal vein arterialization, or multi-visceral transplantation. Among these, CPHT and RPA are the most commonly performed. Generally, CPHT is used in pediatric liver transplantation; however, it is rarely reported in adult living donor liver transplantation (LDLT) due to technical challenges. In this report, we describe our technical modifications to CPHT and present the results in two patients with extensive porto-mesenteric thrombosis who underwent LDLT.
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Makki et al. (2026) studied this question.
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