Liver transplantation for advanced hepatocellular carcinoma combined with portal vein tumor thrombus

Summary: Background: The advanced hepatocellular carcinoma combined with portal vein tumor thrombus(PVTT)once has been the contraindications of liver transplantation which has been changed recently attribute to the development of vascular surgery. However, PVTT confining the entire portal vein and cavernomatous transformation of PV (CTPV) remains a challenge for liver transplantation. This video shows our experience with removal of PVTT and anastomosis of the portal vein in liver transplantation with PVTT. Methods: A 53-year-old female patient with hepatitis B cirrhosis, Transcatheter Hepatic Arterial Chemoembolization has applied four months ago and Radiotherapy was applied one month ago. The CT scan demonstrated portal vein tumor thrombus as well as an arteriovenous fistula. This patient was successfully treated with orthotopic modified piggyback liver transplantation. The distal PV was clamped and then the transection of PV was performed to remove the PVTT after the PV was exposed completely. After that, IVC was partly clamped and the outflow of the graft was reconstructed in a side to side anastomosis. Then, we reconstructed the portal vein by end-to-end anastomosis. The hepatic artery was reconstructed at last. Results: The patient stayed for 7 days in ICU. The immunosuppression used were methylprednisolone, Fk506, and CellCept. The patient recovered smoothly and 15-day discharge after the operation. She has tumor-free survived for two years and survived now. Conclusion: Despite advanced hepatocellular carcinoma combined with portal vein tumor thrombus is not the indication for liver transplantation, this therapy can also give these end-stage patients a flash of hope.