Extensive thrombosis of the portal vein and vena cava after orthotopic liver transplantation with cavoportal hemitransposition: a case report

We report herein a case of orthotopic liver transplantation (OLT) with cavoportal hemitransposition. The patient underwent OLT for hepatitis B virus-related cirrhosis with diffused portomesenteric vein thrombosis (PVT). The unique feature of this case was that 1 month after the operation, because of extensive thrombosis of the portal vein and vena cava in the allografted liver, the hepatic artery was the only vessel to supply the liver. Percutaneous pulse spray thrombolysis through a femoral vein access was incompletely successful with the result that the cavoportal anastomosis stoma occluded and the allografted liver was supplied only by the hepatic artery; the portal vein served no function. Yet the patient survived and was eventually discharged in good condition with normal liver and kidney functions. The patient is alive and well with persistent normalization of hepatic function during 1.5 years follow-up.