Non-tumoral portal vein thrombosis in liver transplantation: Surgical perspectives and institutional protocol

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.