Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.234
Peer-review started: October 7, 2018
First decision: November 15, 2018
Revised: November 27, 2018
Accepted: December 12, 2018
Article in press: December 13, 2018
Published online: February 27, 2019
Portal vein thrombosis (PVT) after liver transplantation (LT) is an uncommon complication with potential for significant morbidity and mortality that transplant providers should be cognizant of. Recognizing subtle changes in post-operative ultrasounds that could herald but do not definitively diagnose PVT is paramount.
A 30-year-old female with a history of alcohol-related cirrhosis presented with painless jaundice and received a deceased donor orthotopic liver transplant. On the first two days post-operatively, her liver Doppler ultrasounds showed a patent portal vein, increased hepatic arterial diastolic flows, and reduced hepatic arterial resistive indices. She was asymptomatic with improving labs. On post-operative day three, her resistive indices declined further, and computed tomography of the abdomen revealed a large extra-hepatic PVT. The patient then underwent emergent percutaneous venography with tissue plasminogen activator administration, angioplasty, and stent placement. Aspirin was started to prevent stent thrombosis. Follow-up ultrasounds showed a patent portal vein and improved hepatic arterial resistive indices. Her graft function improved to normal by discharge. Although decreased hepatic artery resistive indices and increased diastolic flows on ultrasound are often associated with hepatic arterial stenosis post-LT, PVT can also cause these findings.
Reduced hepatic arterial resistive indices on ultrasound can signify PVT post-LT, and thrombolysis, angioplasty, and stent placement are efficacious treatments.
Core tip: Acute portal vein thrombosis (PVT) after liver transplant is uncommon but can cause significant morbidity and mortality. PVT can present with subtle ultrasound abnormalities in the hepatic artery, such as decreased resistive indices and increased diastolic flows, in the absence of frank thrombosis in the portal vein. Long term portal vein patency has been seen with percutaneous thrombolysis, angioplasty, and stent placement as treatment.