Portal vein thrombosis and liver transplantation.

Our attention has been drawn to the June 1992 issue of HOSPITAL PHYSICIAN, particularly the section on Board Review in Internal Medicine.1 reconstruction for various associated occlusive and hypoplastic abnormalities in patients undergoing OLTX. Despite these successes, refinement in technique continues as demonstrated by Tzakis et al5 using the venous jump grafts in PVT in 1989. Furthermore, just recently, Stieber et al6 in 1991, expanded the work on the spectrum of PVr in liver transplantation replete with graphic details on the several techniques currently used to ensure successful revascularization in patients with PVT undergoing OLTX. On the issue of portal vein thrombosis (PVT) in orthotopic liver transplantation (OLTX), we wish to bring to your attention, the response to question 15: "Of the following, which represents the most important contraindication to liver transplantation?" The answer was Portal Vein Thrombosis (D); and the subsequent explanation, "Portal vein thrombosis technically precludes successful liver transplantation." In 1992, PVf by itself, is not a contraindication to OLTX. Rapid advances in liver transplantation over the years, particularly the last decade, have led to the identification and successful resolution of several problems that had previously contraindicated or made liver transplantation a hazardous enterprise.2 Without question, the problem of PVT was a difficult one in OLTX. However, by 1985, Shaw et al3 had reported on the successful reconstruction of the portal vein in two patients with PVT undergoing OLTX. Later in 1986, Lerut et al 4 published the University of Pittsburgh experience (from 1980 to 1984) at not only portal vein but also vena cava As these developments unfolded, Maddrey and Van Thiel7 as far back as 1988 indicated that several problems (PVT being one of them) that had originally been listed as contraindications to liver transplantation were no longer so.