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Portal vein recanalization before liver transplantation

Jan 19, 2026

Project Summary

Background

Chronic obliterative portal vein thrombosis (PVT) remains one of the most challenging vascular conditions in liver transplantation, particularly in patients with Yerdel grade III–IV disease. Although historically regarded as a relative contraindication, advances in endovascular techniques now allow for portal vein recanalization combined with TIPS (PVR-TIPS). This approach restores physiological portal flow, facilitates end-to-end portal anastomosis, and may improve post-transplant outcomes.

Hypothesis

Pre-transplant portal vein recanalization with PVR-TIPS is a safe and effective technique that enables physiological portal anastomosis and optimizes outcomes after liver transplantation.

Design

International Multicenter Retrospective Study

Patients ≥18 years with cirrhosis and obliterative PVT (Yerdel III–IV) who underwent pre-transplant PVR-TIPS and subsequently received a liver transplant with physiological portal anastomosis.

Data will be collected from Hospital Clínic of Barcelona and participating international centers, analyzed jointly as a single multicenter cohort.

Inclusion Criteria

Adult candidates for liver transplantation (≥18 years)

Non-malignant, complete or obliterative PVT (Yerdel III–IV)

Undergoing pre-transplant PVR-TIPS

Exclusion Criteria

Partial portal vein thrombosis (Yerdel I–II)

Failed recanalization attempts

Patients not transplanted after PVR-TIPS

Incomplete clinical or imaging data

Data Collection 

Data will be collected retrospectively and centralized in a REDCap database:

  • Baseline: demographics, etiology, Child-Pugh, MELD-Na, laboratory values, symptoms of portal hypertension
  • Recanalization: access route (transhepatic / transsplenic), persistence of thrombosis, complications, severe adverse events
  • Transplant: donor type, interval between recanalization and transplant, type of portal anastomosis (physiological vs. non-anatomical), intraoperative and postoperative complications
  • Follow-up: portal patency, re-thrombosis, graft survival, and patient survival
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Aims

Objectives 

  • Primary: To evaluate the feasibility and safety of pre-transplant PVR-TIPS in patients with obliterative PVT, with particular emphasis on achieving a physiological portal anastomosis.
  • Secondary: To identify predictors of technical and clinical success, describe peri- and post-transplant complications, and assess graft and patient survival.

Study file(s)

Contact(s)

Yiliam Fundora
fundora@clinic.cat

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