Intraoperative Endovascular Treatment Via the Ligamentum Teres Hepatis in Liver Transplantation for Yerdel Grade Ⅲ/IV Portal Vein Thrombosis: A Safe and Effective Strategy

NCT07192653 | Completed

• 1 other identifier: ChenC
• Study Type: observational
• Target: 75
• Locations: 0 countries
• Sites: N/A

Brief Summary

Background: To evaluate the safety and efficacy of intraoperative endovascular treatment (EVT) using the donor ligamentum teres hepatis (LTH) approach for Yerdel grade III/IV portal vein thrombosis (PVT) during liver transplantation (LT), a condition that poses a major challenge in complex surgeries. Methods: This single-center retrospective cohort study included some patients with grade III/IV PVT who underwent LT and were divided into two periods: in both periods, patients underwent modified eversion thrombectomy. However, in Period 1 (2016-2019), nonanatomical anastomosis was performed if portal flow was insufficient, and in Period 2 (2019-2024), patients with persistent hypoperfusion underwent additional LTH-based EVT (stenting or shunt occlusion). Perioperative outcomes (operative time, anhepatic phase, and anastomosis type) and long-term outcomes (graft survival and complication rates) were compared between groups.

Conditions

Liver Transplantation; Endovascular Treatment

Outcome Measures

Primary Outcomes (6)

• Operative Time

  Operative time refers to the duration from the initial surgical incision to the completion of skin closure.

  Intraoperative

• Anhepatic Phase Time

  The anhepatic phase time is the critical period during liver transplant surgery when the patient's native liver has been removed and the donor liver has not yet been reperfused.

  Intraoperative

• Rate of Nonanatomical Reconstruction

  The rate of nonanatomical resection refers to the frequency with which a surgical procedure removes a tumor without following the boundaries of the organ's functional anatomical units.

  Intraoperative

• Delayed Graft Function

  Delayed graft function is a common complication following kidney transplantation where the transplanted organ does not function immediately, often necessitating dialysis within the first week post-surgery.

  Within 7 days postoperatively

• Portal Vein Complications

  Portal vein complications are a serious concern in liver transplantation, encompassing issues such as thrombosis, stenosis, and occlusion that can threaten graft survival and patient life.

  From the surgery to the last follow-up (median follow-up 28 months)

• Graft Survival

  Graft survival refers to the continued functional existence of a transplanted organ or tissue within a recipient's body.

  1-year and 3-year postoperatively

Study Arms (2)

Period 1

Procedure: nonanatomical anastomosis

Period 2

Procedure: LTH-based EVT

Interventions

nonanatomical anastomosis PROCEDURE

In Period 1 (2016-2019, n=41), nonanatomical anastomosis was performed if portal flow was insufficient.

Period 1

LTH-based EVT PROCEDURE

In Period 2 (2019-2024, n=34), patients with persistent hypoperfusion underwent additional LTH-based EVT (stenting or shunt occlusion)

Period 2

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Conducted a retrospective cohort analysis of 1,478 consecutive adult patients (aged ≥18 years) who underwent deceased-donor liver transplantation at Tianjin First Central Hospital between February 2016 and December 2024.From this population, the investigators identified 75 recipients with Yerdel grade III/IV PVT, which was confirmed by multiphase contrast-enhanced CT, indirect portography, and intraoperative evaluation. Exclusion criteria were living-donor and split-liver procedures. All procedures were performed using classic orthotopic transplantations. To evaluate the evolution of our PVT management strategy, the investigators divided the cohort into two chronologically distinct periods: period 1 (pre-intervention): February 2016-January 2019 (n=41), and period 2 (LTH protocol): February 2019-December 2024 (n=34).

You may qualify if:

• Adult patients (aged ≥18 years).
• Patients underwent deceased-donor liver transplantation.
• At Tianjin First Central Hospital between February 2016 and December 2024.
• Identified recipients with Yerdel grade III/IV PVT, which was confirmed by multiphase contrast-enhanced CT, indirect portography, and intraoperative evaluation

You may not qualify if:

• All procedures were performed using classic orthotopic transplantations.

Sponsors & Collaborators

• Chiyi Chen: lead

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Attending physician

Study Record Dates

• First Submitted: September 10, 2025
• First Posted: September 25, 2025
• Study Start: February 1, 2016
• Primary Completion: December 1, 2024
• Study Completion: April 1, 2025
• Last Updated: September 25, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share