Preoperative portal vein recanalization–transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation

High‐grade portal vein thrombosis (PVT) is often considered to be a technically challenging scenario for liver transplantation (LT) and in some centers a relative contraindication. This study compares patients with chronic obliterative PVT who underwent portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR‐TIPS) and subsequent LT to those with partial nonocclusive PVT who underwent LT without an intervention. This institutional review board‐approved study analyzed 49 patients with cirrhosis with PVT from 2000 to 2020 at our institution. Patients were divided into two groups, those that received PVR‐TIPS due to anticipated surgical challenges from chronic obliterative PVT and those who did not because of partial PVT. Demographic data and long‐term outcomes were compared. A total of 35 patients received PVR‐TIPS while 14 did not, with all receiving LT. Patients with PVR‐TIPS had a higher Yerdel score and frequency of cavernoma than those that did not. PVR‐TIPS was effective in decreasing portosystemic gradient (16 down to 8 mm HG; p < 0.05). Both groups allowed for end‐to‐end anastomoses in >90% of cases. However, veno–veno bypass was used significantly more in patients who did not receive PVR‐TIPS. Additionally, patients without PVR‐TIPS required significantly more intraoperative red blood cells. Overall survival was not different between groups. PVR‐TIPS demonstrated efficacy in resolving PVT and allowed for end‐to‐end portal vein anastomoses. PVR‐TIPS is a viable treatment option for chronic obliterative PVT with or without cavernoma that simplifies the surgical aspects of LT.