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P9.50 Novel MLTR classification of portal vein thrombosis for purposes of liver transplantation

Boris I Yaremin, Russian Federation

Transplant Surgeon
Liver Transplantation Center
Sklifosovsky Emergency Medicine Institute

Abstract

Novel MLTR classification of portal vein thrombosis for purposes of liver transplantation

Bakhtiyar Kazymov1, Murad Novruzbekov1, Boris Yaremin1, Konstantin Lutsyk1, Oleg Olisov1.

1Liver Transplantation Center, Sklifosovsky Emergency Medicine Institute, Moscow, Russian Federation

Portal vein thrombosis (PVT) is a common complication of decompensated liver cirrhosis and occurs in 0.6-26% of patients on waiting lists. In a population of patients with liver cirrhosis, PVT develops within a year in 4.6-12.8%, in 10.2-20% within 5 years, and within 8-10 years in 38.7%. The Liver Transplant Center of the Sklifosovsky Institute in Moscow is the leading transplant center in Russia, which performs liver transplants for portal vein thrombosis - such patients occur on the waiting list of the center up to 30%. The practice of the center led to the need to create its own classification, which would allow making decisions on the waiting list and intraoperatively.
For the purposes of liver transplantation, especially if transplantation is planned from a living related donor, it is possible to propose a classification of portal vein thrombosis that would be applicable to address tactical issues in liver transplantation. A variant of such a classification, which may be called MLTR, is given in Table 1.

Table 1. MLTR classification of portal vein thrombosis

Letter Designation
M Thrombosis of the mesenteric veins
0 - no thrombosis
1 - non-occlusive thrombosis of one of the veins
2 - occlusive thrombosis of one of the veins
L Thrombosis of the splenic veins
0 - no thrombosis
1 - non-occlusive thrombosis
2 - occlusive thrombosis
T Thrombosis of the portal vein
0 - no thrombosis
1 - non-occlusive thrombosis
2 - occlusive thrombosis
R Thrombosis of the branches of the portal vein
0 - no thrombosis
1 - non-occlusive thrombosis
2 - occlusive thrombosis

In the presence of calcification, the letters ca are added, in the presence of cavernous transformation ct.

Visually, the classification is presented in fig. 1.

The developed classification was introduced into the work of the liver transplantation center of the N.V. Sklifosovsky. The clinical material consisted of 650 patients of the liver transplantation center of the N.V. Sklifosovsky operated from 2000 to 2020.
Patients with PVT M0L0T1R0 accounted for 25% of the total number of patients, with M1L0T2R0 - half, with M1L1T2R0-1 - 25%. Based on the developed classification, the tactics of surgical treatment of patients was determined as follows. The developed classification was used to determine intraoperative tactics. In the presence of M1-2L0-1, the retropancreatic portal vein and its confluence were mobilized, for which the head of the pancreas was mobilized. This technique made it possible in some cases to perform eversion thrombinthymectomy without performing plastic or bypass interventions. In the presence of T3, thrombinthymectomy was not performed; it was planned to perform shunting or prosthetics of the portal vein. The presence of R1-2 prior to transplantation was of little hemodynamic significance. Thus, we can conclude that the developed classification was used by us to make a decision during liver transplantation.

The authors would like to thank Maria Kozhevnikova for her help in illustrating our work.

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