Portal vein surgical treatment on non-tumoral portal vein thrombosis in liver transplantation: Systematic Review and Meta-Analysis

Nacif, Lucas S.; Zanini, Leonardo Y.; Pinheiro, Rafael S.; Waisberg, Daniel R.; Rocha-Santos, Vinicius; Andraus, Wellington; Carrilho, Flair J.; Carneiro-D'Albuquerque, Luiz

doi:10.6061/clinics/2021/e2184

Lucas S. Nacif ^**Corresponding author. E-mail: lucasnacif@usp.br

Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0002-7059-3978

Leonardo Y. Zanini

Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0002-1358-4303

Rafael S. Pinheiro

Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0001-8632-3529

Daniel R. Waisberg

Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0003-4284-0633

Vinicius Rocha-Santos

Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0002-2643-6094

Wellington Andraus

Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0002-5162-138X

Flair J. Carrilho

Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0002-7682-3105

Luiz Carneiro-D'Albuquerque

Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0001-7607-7168

*Corresponding author. E-mail: lucasnacif@usp.br

No potential conflict of interest was reported.

All authors have approved the final draft of the manuscript submitted. Nacif LS was responsible for the study conception and design, data collection, analysis and interpretation, manuscript writing, and literature search. Zanini LY, Waisberg DR, Pinheiro RS were responsible for the study conception and design, data collection, analysis and interpretation, manuscript critical review. Rocha-Santos V was responsible for the study conception, interpretation and critical revision. Andraus W, Carrilho FJ and Carneiro-D’Albuquerque L were responsible for the study conception, interpretation, and critical review.

	Selection	Comparability	Outcome	NOS Score
Nonrandomized clinical trial
Gayovsky et al. (³⁰30. Gayowski TJ, Marino IR, Doyle HR, Echeverri L, Mieles L, Todo S, et al. A high incidence of native portal vein thrombosis in veterans undergoing liver transplantation. J Surg Res. 1996;60(2):333-8. https://doi.org/10.1006/jsre.1996.0053. https://doi.org/10.1006/jsre.1996.0053... )	+++	+	++	NOS: 6
Seu et al. (³¹31. Seu P, Shackleton CR, Shaked A, Imagawa DK, Olthoff KM, Rudich SR, et al. Improved results of liver transplantation in patients with portal vein thrombosis. Arch Surg. 1996;131(8):840-4; discussion 844-5. https://doi.org/10.1001/archsurg.1996.01430200050009. https://doi.org/10.1001/archsurg.1996.01... )	+++	+	+++	NOS: 7
Lerut et al. (³²32. Lerut JP, Mazza D, van Leeuw V, Laterre PF, Donataccio M, de Ville de Goyet J, et al. Adult liver transplantation and abnormalities of splanchnic veins: experience in 53 patients. Transpl Int. 1997;10(2):125-32. https://doi.org/10.1111/j.1432-2277.1997.tb00554.x. https://doi.org/10.1111/j.1432-2277.1997... )	++++	+	+++	NOS: 8
Karatzas et al. (³³33. Karatzas T, Lykaki-Karatzas E, Demirbas A, Tsaroucha A, Phipps J, Nery J, et al. Management of portal vein thrombosis in liver transplantation. Transplant Proc. 1997;29(7):2866-7. https://doi.org/10.1016/S0041-1345(97)00711-2. https://doi.org/10.1016/S0041-1345(97)00... )	+++	+	+++	NOS: 7
Yerdel et al. (⁵5. Yerdel MA, Gunson B, Mirza D, Karayalçin K, Olliff S, Buckels J, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000;69(9):1873-81. https://doi.org/10.1097/00007890-200005150-00023. https://doi.org/10.1097/00007890-2000051... )	++++	+	+++	NOS: 8
Dumortier et al. (³⁴34. Dumortier J, Czyglik O, Poncet G, Blanchet MC, Boucaud C, Henry L, et al. Eversion thrombectomy for portal vein thrombosis during liver transplantation. Am J Transplant. 2002;2(10):934-8. https://doi.org/10.1034/j.1600-6143.2002.21009.x. https://doi.org/10.1034/j.1600-6143.2002... )	+++	+	+++	NOS: 7
Loinanz et al. (²⁷27. Loinaz C, Gómez R, Jiménez J, González-Pinto I, García I, Gimeno A, et al. Liver transplantation in patients with portal thrombosis: results in 76 patients. Transplant Proc. 2002;34(1):248-9. https://doi.org/10.1016/S0041-1345(01)02746-4. https://doi.org/10.1016/S0041-1345(01)02... )	+++	+	+++	NOS: 7
Molmenti et al. (²⁹29. Molmenti EP, Roodhouse TW, Molmenti H, Jaiswal K, Jung G, Marubashi S, et al. Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. Ann Surg. 2002;235(2):292-6. https://doi.org/10.1097/00000658-200202000-00019. https://doi.org/10.1097/00000658-2002020... )	+++	+	++++	NOS: 8
Berteli et al. (¹⁰10. Bertelli R, Nardo B, Montalti R, Beltempo P, Puviani L, Cavallari A. Liver transplantation in recipients with portal vein thrombosis: experience of a single transplant center. Transplant Proc. 2005;37(2):1119-21. https://doi.org/10.1016/j.transproceed.2005.01.031. https://doi.org/10.1016/j.transproceed.2... )	+++	+	+++	NOS: 7
Gimeno et al. (¹⁸18. Gimeno FA, Calvo J, Loinaz C, Meneu JC, Pérez B, Gomez R, et al. Comparative analysis of the results of orthotopic liver transplantation in patients with and without portal vein thrombosis. Transplant Proc. 2005;37(9):3899-903. https://doi.org/10.1016/j.transproceed.2005.10.085. https://doi.org/10.1016/j.transproceed.2... )	+++	+	++	NOS: 6
Lendoire et al. (³⁵35. Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, et al. Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome. HPB (Oxford). 2007;9(5):352-6. https://doi.org/10.1080/13651820701599033. https://doi.org/10.1080/1365182070159903... )	+++	+	++	NOS: 6
Arcadipane et al. (¹³13. Arcadipane A, Nadalin S, Gruttadauria S, Panarello G, Burgio G, Vizzini G, et al. The recipient with portal thrombosis and/or previous surgery. Transplant Proc. 2008;40(4):1183-6. https://doi.org/10.1016/j.transproceed.2008.03.073. https://doi.org/10.1016/j.transproceed.2... )	++++	+	+++	NOS: 8
Cho et al. (²⁶26. Cho JY, Suh KS, Shin WY, Lee HW, Yi NJ, Lee KU. Thrombosis confined to the portal vein is not a contraindication for living donor liver transplantation. World J Surg. 2008;32(8):1731-7. https://doi.org/10.1007/s00268-008-9651-4. https://doi.org/10.1007/s00268-008-9651-... )	+++	+	++	NOS: 6
Lladó et al. (²¹21. Lladó L, Fabregat J, Castellote J, Ramos E, Torras J, Jorba R, et al. Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality. Clin Transplant. 2007;21(6):716-21. https://doi.org/10.1111/j.1399-0012.2007.00728.x. https://doi.org/10.1111/j.1399-0012.2007... )	++++	+	+++	NOS: 8
Suarez Artacho et al. (¹²12. Suarez Artacho G, Barrera Pulido L, Alamo Martinez JM, Serrano Diez-Canedo J, Bernal Bellido C, Marin Gomez LM, et al. Outcomes of liver transplantation in candidates with portal vein thrombosis. Transplant Proc. 2010;42(8):3156-8. https://doi.org/10.1016/j.transproceed.2010.05.057. https://doi.org/10.1016/j.transproceed.2... )	+++	+	+++	NOS: 7
Kim et al. (²⁰20. Kim SJ, Kim DG, Park JH, Moon IS, Lee MD, Kim JI, et al. Clinical analysis of living donor liver transplantation in patients with portal vein thrombosis. Clin Transplant. 2011;25(1):111-8. https://doi.org/10.1111/j.1399-0012.2010.01217.x. https://doi.org/10.1111/j.1399-0012.2010... )	+++	+	+++	NOS: 7
Pan et al. (²⁵25. Pan C, Shi Y, Zhang JJ, Deng YL, Zheng H, Zhu ZJ, et al. Single-center experience of 253 portal vein thrombosis patients undergoing liver transplantation in China. Transplant Proc. 2009;41(9):3761-5. https://doi.org/10.1016/j.transproceed.2009.06.215. https://doi.org/10.1016/j.transproceed.2... )	+++	+	+++	NOS: 7
Tao et al. (¹¹11. Tao YF, Teng F, Wang ZX, Guo WY, Shi XM, Wang GH, et al. Liver transplant recipients with portal vein thrombosis: a single center retrospective study. Hepatobiliary Pancreat Dis Int. 2009;8(1):34-9.)	++++	+	+++	NOS: 8
Englesbe et al. (¹⁵15. Englesbe MJ, Schaubel DE, Cai S, Guidinger MK, Merion RM. Portal vein thrombosis and liver transplant survival benefit. Liver Transpl. 2010;16(8):999-1005. https://doi.org/10.1002/lt.22105. https://doi.org/10.1002/lt.22105... )	++++	+	+++	NOS: 8
Wu et al. (¹⁴14. Wu TH, Lin YS, Lee CF, Wu TJ, Yu MC, Chan KM, et al. Clinical analysis and strategy for liver transplantation in patients with pre-existing portal vein thrombosis. Chang Gung Med J. 2011;34(4):426-34.)	+++	+	+++	NOS: 7
Bhangui et al. (²⁸28. Bhangui P, Lim C, Salloum C, Andreani P, Sebbagh M, Hoti E, et al. Caval inflow to the graft for liver transplantation in patients with diffuse portal vein thrombosis: a 12-year experience. Ann Surg. 2011;254(6):1008-16. https://doi.org/10.1097/SLA.0b013e31822d7894. https://doi.org/10.1097/SLA.0b013e31822d... )	+++	+	++	NOS: 6
Ravaioli et al. (¹⁶16. Ravaioli M, Zanello M, Grazi GL, Ercolani G, Cescon M, Del Gaudio M, et al. Portal vein thrombosis and liver transplantation: evolution during 10 years of experience at the University of Bologna. Ann Surg. 2011;253(2):378-84. https://doi.org/10.1097/SLA.0b013e318206818b. https://doi.org/10.1097/SLA.0b013e318206... )	++++	+	+++	NOS: 8
D’Amico et al. (²²22. D’Amico G, Tarantino G, Spaggiari M, Ballarin R, Serra V, Rumpianesi G, et al. Multiple ways to manage portal thrombosis during liver transplantation: surgical techniques and outcomes. Transplant Proc. 2013;45(7):2692-9. https://doi.org/10.1016/j.transproceed.2013.07.046. https://doi.org/10.1016/j.transproceed.2... )	++++	+	+++	NOS: 8
Hibi et al. (¹⁹19. Hibi T, Nishida S, Levi DM, Selvaggi G, Tekin A, Fan J, et al. When and why portal vein thrombosis matters in liver transplantation: a critical audit of 174 cases. Ann Surg. 2014;259(4):760-6. https://doi.org/10.1097/SLA.0000000000000252. https://doi.org/10.1097/SLA.000000000000... )	++++	+	+++	NOS: 8
Gao et al. (²³23. Gao PJ, Gao J, Li Z, Hu ZP, Leng XS, Zhu JY. Liver transplantation in adults with portal vein thrombosis: Data from the China Liver Transplant Registry. Clin Res Hepatol Gastroenterol. 2016;40(3):327-32. https://doi.org/10.1016/j.clinre.2015.05.010. https://doi.org/10.1016/j.clinre.2015.05... )	+++	+	++	NOS: 6
Song et al. (²⁴24. Song S, Kwon CH, Kim JM, Joh JW, Lee SK. Single-center experience of living donor liver transplantation in patients with portal vein thrombosis. Clin Transplant. 2016;30(9):1146-51. https://doi.org/10.1111/ctr.12803. https://doi.org/10.1111/ctr.12803... )	+++	+	+++	NOS: 7
Hernandez-Conde et al. (¹⁷17. Hernández-Conde M, Llop Herrera E, de la Revilla Negro J, Pons Renedo F, Fernández Puga N, Martínez-Porras JL, et al. Prevalence and outcome of portal thrombosis in a cohort of cirrhotic patients undergoing liver transplantation. Rev Esp Enferm Dig. 2016;108(11):716-20.)	+++	+	+++	NOS: 7

Article	Baseline data	PVT Classification	PVT - Surgery Technique	Outcome
Gayovsky et al. (³⁰30. Gayowski TJ, Marino IR, Doyle HR, Echeverri L, Mieles L, Todo S, et al. A high incidence of native portal vein thrombosis in veterans undergoing liver transplantation. J Surg Res. 1996;60(2):333-8. https://doi.org/10.1006/jsre.1996.0053. https://doi.org/10.1006/jsre.1996.0053... ) (n=23) DDLT	Mean age 46 years; 23 males; mean CTP score 12	Yerdel I (n=6) Yerdel III (n=13) Yerdel III (n=13)	6 Thrombectomy 4 Thrombectomy 1 Thrombectomy 1 Graft interposition 11 Jumpgraft SMV	- Worst graft survival (no-PVT group 86% vs PVT group 65%, 1 year; p=0.03) - Higher operative blood loss
Seu et al. (³¹31. Seu P, Shackleton CR, Shaked A, Imagawa DK, Olthoff KM, Rudich SR, et al. Improved results of liver transplantation in patients with portal vein thrombosis. Arch Surg. 1996;131(8):840-4; discussion 844-5. https://doi.org/10.1001/archsurg.1996.01430200050009. https://doi.org/10.1001/archsurg.1996.01... ) (n=70) DDLT	48 males and 22 female; 26 (37%) patients with hepatitis cirrhosis	-	61 Thrombectomy 1 Graft interposition 2 Graft interposition coronary vein6 Jumpgraft SMV	-Worst survival -Higher blood transfusion -Higher retransplant rates
Lerut et al. (³²32. Lerut JP, Mazza D, van Leeuw V, Laterre PF, Donataccio M, de Ville de Goyet J, et al. Adult liver transplantation and abnormalities of splanchnic veins: experience in 53 patients. Transpl Int. 1997;10(2):125-32. https://doi.org/10.1111/j.1432-2277.1997.tb00554.x. https://doi.org/10.1111/j.1432-2277.1997... (n=32) DDLT	No demographic data	-	22 Thrombectomy 6 SMV implantation 1 T-T anastomosis with donor PV and SMV receptor 2 Confluence dissection 1 Collateral anastomosis	2 patients underwent thrombectomy and 1 patient underwent confluence dissection died with less of 3 months after LT
Karatzas et al. (³³33. Karatzas T, Lykaki-Karatzas E, Demirbas A, Tsaroucha A, Phipps J, Nery J, et al. Management of portal vein thrombosis in liver transplantation. Transplant Proc. 1997;29(7):2866-7. https://doi.org/10.1016/S0041-1345(97)00711-2. https://doi.org/10.1016/S0041-1345(97)00... ) (n=26) DDLT	No demographic data	-	14 Thrombectomy 8 Jumpgraft SMV 4 CPH	-None interposition failed -Patients with PVT were worst
Yerdel et al. (⁵5. Yerdel MA, Gunson B, Mirza D, Karayalçin K, Olliff S, Buckels J, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000;69(9):1873-81. https://doi.org/10.1097/00007890-200005150-00023. https://doi.org/10.1097/00007890-2000051... ) (n=63) DDLT	11% of men presented PVT and 6% of women.High incidence in PVT in patients CTP grade C.	Yerdel I (n=24)Yerdel II (n=23)	4 None 17 low dissection with anastomosis to segment proximal to the thrombus3 Thrombectomy 3 Anastomosis to segment proximal to the thrombus 20 Thrombectomy	-None rethrombosis -Results as well no-PVT -2 patients with rethrombosis. -Higher mortality
		Yerdel III (n=6)	5 Jumpgraft SMV 1 Anastomosis T-T donor PV directly to the receptor PV	-None rethrombosis -Higher mortality
		Yerdel IV (n=10)	2 Thrombectomy 7 Collateral anastomosis 1 Graft interposition collateral	-1 rethrombosis. -Higher mortality (50% overall mortality rate)
Dumortier et al. (³⁴34. Dumortier J, Czyglik O, Poncet G, Blanchet MC, Boucaud C, Henry L, et al. Eversion thrombectomy for portal vein thrombosis during liver transplantation. Am J Transplant. 2002;2(10):934-8. https://doi.org/10.1034/j.1600-6143.2002.21009.x. https://doi.org/10.1034/j.1600-6143.2002... )(n=38) DDLT	No demoghaphic data	Partial PVT (n=34) Total PVT (n=4)	34 Thrombectomy 4 Thrombectomy	-1 patient had recurrence of thrombosis 6 hours after LT (total PVT) -10 patients died after LT with median time 10 months (range 0 - 72 months)
Loinaz et al. (²⁷27. Loinaz C, Gómez R, Jiménez J, González-Pinto I, García I, Gimeno A, et al. Liver transplantation in patients with portal thrombosis: results in 76 patients. Transplant Proc. 2002;34(1):248-9. https://doi.org/10.1016/S0041-1345(01)02746-4. https://doi.org/10.1016/S0041-1345(01)02... ) (n=76) DDLT	Mean age 45.7±13.7 years; 21 male and 6 female Mean age 48.4±11.3 years; 36 male and 13 female	LT before 1993(group A) (n=27) LT since 1993(group B) (n=49)	75 Thrombectomy 1 Jumpgraft SMV	-Retransplant higher than group B -5 rethrombosis (4 before 3 months) -None rethrombosis -Better survival after LT in comparison of group A
Molmenti et al. (²⁹29. Molmenti EP, Roodhouse TW, Molmenti H, Jaiswal K, Jung G, Marubashi S, et al. Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. Ann Surg. 2002;235(2):292-6. https://doi.org/10.1097/00000658-200202000-00019. https://doi.org/10.1097/00000658-2002020... ) (n=85) DDLT	Mean age 53.0±9.1 years ; 54 male and 31 female	-	85 Thrombectomy	-Results as well no -PVT
Berterlli et al. (¹⁰10. Bertelli R, Nardo B, Montalti R, Beltempo P, Puviani L, Cavallari A. Liver transplantation in recipients with portal vein thrombosis: experience of a single transplant center. Transplant Proc. 2005;37(2):1119-21. https://doi.org/10.1016/j.transproceed.2005.01.031. https://doi.org/10.1016/j.transproceed.2... ) (n=64) DDLT	The only preoperative parameter associated with PVT was CTP grade C(p < 0.005).	Partial PVT (n=39) Complete PVT(n=25)	38 Thrombectomy 1 Jumpgraft SMV 18 Thrombectomy 6 Jumpgraft SMV 1 CPH	-1 patient that underwent thrombectomy had recurrence of PVT. -2 patient underwent thrombectomy had recurrence of PVT.
Gimeno et al. (¹⁸18. Gimeno FA, Calvo J, Loinaz C, Meneu JC, Pérez B, Gomez R, et al. Comparative analysis of the results of orthotopic liver transplantation in patients with and without portal vein thrombosis. Transplant Proc. 2005;37(9):3899-903. https://doi.org/10.1016/j.transproceed.2005.10.085. https://doi.org/10.1016/j.transproceed.2... ) (n=83) DDLT	Mean age 50.61±9.22; 62 men and 21 female. The main LT indication was alcohol cirrhosis	-	-	-Higher recurrence of PVT
Lendoire et al. (³⁵35. Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, et al. Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome. HPB (Oxford). 2007;9(5):352-6. https://doi.org/10.1080/13651820701599033. https://doi.org/10.1080/1365182070159903... ) (n=26) DDLT	Median age 40 years (range 17-61); 14 male and 12 female. Preoperative PVT diagnosis In 9 patients. CTP grade C in 61.5%	Yerdel I (n=13) Yerdel II (n=5) Yerdel III (n=5) Yerdel IV (n=3)	13 Thrombectomy 5 Thrombectomy 5 Jumpgraft VMS 3 Thrombectomy	-Better survival rates -2 retrasplantation. -2 retrasplantation. -1 retrasplantation. -2 patients were alive at 68 and 128 months post-transplant, respectively
Arcadipane et al. (¹³13. Arcadipane A, Nadalin S, Gruttadauria S, Panarello G, Burgio G, Vizzini G, et al. The recipient with portal thrombosis and/or previous surgery. Transplant Proc. 2008;40(4):1183-6. https://doi.org/10.1016/j.transproceed.2008.03.073. https://doi.org/10.1016/j.transproceed.2... ) (n=33) DDLT	Mean age 53.6 years; 20 male and 13 female; mean MELD 21.4	-	-	-3 patients had recurrence of PVT until 6 months after LT
Cho et al. (²⁶26. Cho JY, Suh KS, Shin WY, Lee HW, Yi NJ, Lee KU. Thrombosis confined to the portal vein is not a contraindication for living donor liver transplantation. World J Surg. 2008;32(8):1731-7. https://doi.org/10.1007/s00268-008-9651-4. https://doi.org/10.1007/s00268-008-9651-... ) (n=22) LDLT	Mean age 48.9±10.27; 15 men and 7 women; mean MELD 21.2±7.0	Yerdel I (n=9) Yerdel II (n=6) Yerdel III (n=2)	22 Thrombectomy	Rethrombosis rate was higher in the group with PVT+SMV proximal thrombosis (28.6%), with higher mortality
Lladó et al. (²¹21. Lladó L, Fabregat J, Castellote J, Ramos E, Torras J, Jorba R, et al. Management of portal vein thrombosis in liver transplantation: influence on morbidity and mortality. Clin Transplant. 2007;21(6):716-21. https://doi.org/10.1111/j.1399-0012.2007.00728.x. https://doi.org/10.1111/j.1399-0012.2007... ) (n=42)	Mean age 55.6±7.9;33 men and 9 female; CTP grade A 6 patients, B grade 30 and 6 grade C. The main etiology was alcohol cirrhosis	Yerdel I (n=18) Yerdel II (n=16) Yerdel III (n=6) Yerdel IV (n=2)	12 T-T anastomosis 6 Thrombectomy 9 Thrombectomy 4 SMV confluence 2 Collateral anastomosis1 Graft interposition1 Thrombectomy 1 SMV confluence 2 Collateral anastomosis 2 Jumpgraft SMV2 Collateral anastomosis 1 CPH	None complication 2 patients required stent, due to PV rethrombosis. 1 patient with SMV confluence anastomosis required postoperative stent, due to PV stenosis. 1 patient with collateral anastomosis evaluated with PV stenosis and required stent. The patient underwent caval transposition died due to liver failure.
Artacho et al. (¹²12. Suarez Artacho G, Barrera Pulido L, Alamo Martinez JM, Serrano Diez-Canedo J, Bernal Bellido C, Marin Gomez LM, et al. Outcomes of liver transplantation in candidates with portal vein thrombosis. Transplant Proc. 2010;42(8):3156-8. https://doi.org/10.1016/j.transproceed.2010.05.057. https://doi.org/10.1016/j.transproceed.2... ) (n=48) DDLT	Mean age 53 years; 37 men and 11 female; 38 intraoperative PVT	Partial PVT (n=28)	26 Thrombectomy 1 Jumpgraft SMV 1 CPH	-2 recurrence of PVT -Mortality rates similar with no -PVT
		Complete PVT (n=20 )	10 Thrombectomy 3 Jumpgraft SMV 3 CPH 3 Collateral anastomosis 1 RPA	-2 recurrence of PVT -PVT show higher mortality
Kim et al. (²⁰20. Kim SJ, Kim DG, Park JH, Moon IS, Lee MD, Kim JI, et al. Clinical analysis of living donor liver transplantation in patients with portal vein thrombosis. Clin Transplant. 2011;25(1):111-8. https://doi.org/10.1111/j.1399-0012.2010.01217.x. https://doi.org/10.1111/j.1399-0012.2010... ) (n=50) LDLT	Mean age 52.3±6.7; 27 male and 12 female; CTP score 9.8±1.9; MELD score 16.7±8.5	Partial PVT (n=39)	38 Thrombectomy 1 Graft interposition	-None PVT recurrence -The survival didn’t differed significantly
	Mean age 51.7±7.1; 10 male and 1 female; CTP score 9.6±1.6; MELD score 17.6±6.8	Complete PVT (n=11)	6 Thrombectomy 2 Jumpgraft to SMV 3 Jumpgraft to coronary vein	-1 PV obstruction after LT -The survival did not differed significantly too.
Pan et al. (²⁵25. Pan C, Shi Y, Zhang JJ, Deng YL, Zheng H, Zhu ZJ, et al. Single-center experience of 253 portal vein thrombosis patients undergoing liver transplantation in China. Transplant Proc. 2009;41(9):3761-5. https://doi.org/10.1016/j.transproceed.2009.06.215. https://doi.org/10.1016/j.transproceed.2... ) (n=252) DDLT	Sex and previous splenectomy increased the risk of PVT	Yerdel I (n=104) Yerdel II (n=114) Yerdel III (n=29)	104 Thrombectomy 114 Thrombectomy 23 Thrombectomy 4 Jumpgraft to SMV 1 CPH 1 RPA	-Higher blood transfusion in comparison with no-PVT LT -1-year survival wasn’t significantly differed -1 patient Yerdel IV underwent to RPA died due to hepatic failure
		Yerdel IV (n=6)	3 Jumpgraft to SMV 1 CPH 2 RPA
Tao et al. (¹¹11. Tao YF, Teng F, Wang ZX, Guo WY, Shi XM, Wang GH, et al. Liver transplant recipients with portal vein thrombosis: a single center retrospective study. Hepatobiliary Pancreat Dis Int. 2009;8(1):34-9.) (n=42) DDLT	Previous treatment of PVT and increasing age are related with higher risk of PVT	Yerdel I (n=19) Yerdel II (n=14) Yerdel III (n=7) Yerdel IV (n=2)	T-T anastomosis with/without thrombectomy 2 Jumpgraft to SMV 2 Donor PV longer anastomosis with recipient PV 3 Anastomosis with coronary vein/splenic vein/umbilical vein 2 CPH	-1 PV rethrombosis -2 patients had postoperative renal failure and 3 LT had graft rejection -2 patients had postoperative renal failure -4 patients presented graft rejection -1 PV rethrombosis -2 patients had postoperative renal failure -2 patients had graft rejection -1 PV rethrombosis
Englesbe et al. (¹⁵15. Englesbe MJ, Schaubel DE, Cai S, Guidinger MK, Merion RM. Portal vein thrombosis and liver transplant survival benefit. Liver Transpl. 2010;16(8):999-1005. https://doi.org/10.1002/lt.22105. https://doi.org/10.1002/lt.22105... ) (n=897) DDLT	Mean age 54.0±9; MELD score 21.8±8.7	-	-	PVT indicate higher postoperative mortality in LT
Wu et al. (¹⁴14. Wu TH, Lin YS, Lee CF, Wu TJ, Yu MC, Chan KM, et al. Clinical analysis and strategy for liver transplantation in patients with pre-existing portal vein thrombosis. Chang Gung Med J. 2011;34(4):426-34.) (n=24) DDLT (n=6) LDLT (n=18)	Mean age 52.0± 10.0;19 male and 5 female;main etiology was HBV;17 patients had MELD score < 20 and 1 with >40	Yerdel I (n=7) Yerdel II (n=11) Yerdel III (n=6)	13 Thrombectomy 3 Graft interposition 1 Anastomosis to coronary vein 4 Jumpgraft to SMV 3 Jumpgraft to coronary vein	-7 patients died 3 months after LT (1 patient 7^th postoperative day due to PVT recurrence follow by graft failure)
Bhangui et al. (²⁸28. Bhangui P, Lim C, Salloum C, Andreani P, Sebbagh M, Hoti E, et al. Caval inflow to the graft for liver transplantation in patients with diffuse portal vein thrombosis: a 12-year experience. Ann Surg. 2011;254(6):1008-16. https://doi.org/10.1097/SLA.0b013e31822d7894. https://doi.org/10.1097/SLA.0b013e31822d... ) (n=20) DDLT (n=26)Domino (n=2) LDLT (n=1) Split (n=1)	Mean age 48±12; 14 male and 6 female; Most common etiology was hepatitis C cirrhosis (n=6)	Yerdel IV (n=20)	3 CPH 17 RPA	-1 patient RPA died 3 months after LT, due to a ruptured cerebral vascular malformation (In this case was not evidenced complication related of LT and RPA)
Ravaioli et al. (¹⁶16. Ravaioli M, Zanello M, Grazi GL, Ercolani G, Cescon M, Del Gaudio M, et al. Portal vein thrombosis and liver transplantation: evolution during 10 years of experience at the University of Bologna. Ann Surg. 2011;253(2):378-84. https://doi.org/10.1097/SLA.0b013e318206818b. https://doi.org/10.1097/SLA.0b013e318206... ) (n=91) DDLT	Mean age 53±9;male 66 and female 25; main etiology was VHC cirrhosis; CTP 1 grade A, 16 grade B and 55 grade C	Partial PVT (n=50) Total PVT (n=41)	50 Thrombectomy 26 Thrombectomy 6 Jumpgraft of SMV 6 CPH 3 Anastomosis with collateral	-Higher recurrence of PVT -Survival was not significantly different among the groups
D’Amico et al. (²²22. D’Amico G, Tarantino G, Spaggiari M, Ballarin R, Serra V, Rumpianesi G, et al. Multiple ways to manage portal thrombosis during liver transplantation: surgical techniques and outcomes. Transplant Proc. 2013;45(7):2692-9. https://doi.org/10.1016/j.transproceed.2013.07.046. https://doi.org/10.1016/j.transproceed.2... ) (n=51) DDLT	Mean age 57.5±7.2;male 41 and female 10; main etiology hepatitis cirrhosis; MELD score 18.5±7.1; BMI 24.9±3.2	Partial PVT (n=44) Total PVT (n=7)	39 Thrombectomy 7 Anastomoses at confluence of the SMV 1 T-T anastomosis 4 Extra-anatomic jumpgraft SMV	- PVT increase risk of PVT recurrence and PNF, but didn’t have impact in overall mortality
Hibi et al. (¹⁹19. Hibi T, Nishida S, Levi DM, Selvaggi G, Tekin A, Fan J, et al. When and why portal vein thrombosis matters in liver transplantation: a critical audit of 174 cases. Ann Surg. 2014;259(4):760-6. https://doi.org/10.1097/SLA.0000000000000252. https://doi.org/10.1097/SLA.000000000000... ) (n=174) DDLT	Median age 55 (49-62); 104 male and 45 female; MELD score 20 (16-24); the main etiology was VHC with 71 LT	Physiological reconstruction (n=149)	123 T-T anastomosis 16 Graft Interposition 10 Jumpgraft SMV	-Higher recurrence of PVT
	Median age 54 (47-60);16 male and 9 female; MELD score 18 (15-26); the main etiologies were VHC with 7 VHC and 7 cryptogenic cirrhosis	N-physiological reconstruction (n =25)	6 RPA18 CPH1 Portal vein arterialization	-Longest hospital stay -High in-hospital mortality
Gao et al. (²³23. Gao PJ, Gao J, Li Z, Hu ZP, Leng XS, Zhu JY. Liver transplantation in adults with portal vein thrombosis: Data from the China Liver Transplant Registry. Clin Res Hepatol Gastroenterol. 2016;40(3):327-32. https://doi.org/10.1016/j.clinre.2015.05.010. https://doi.org/10.1016/j.clinre.2015.05... ) (n=1810) DDLT	Mean age 49.81±9.40; 1521 male and 289 female; MELD score 16.85±8.16; the main etiology was VHB	Yerdel I and II (n=1649) Yerdel III (n=26) Yerdel IV (n=22)	1649 T-T anastomosis 19 Jumpgraft SMV 8 Anastomosis T-T portal- SMV 9 CPH 13 Collateral anastomosis	PVT increase the surgical difficult, however didn’t increase mortality rate
Song et al. (²⁴24. Song S, Kwon CH, Kim JM, Joh JW, Lee SK. Single-center experience of living donor liver transplantation in patients with portal vein thrombosis. Clin Transplant. 2016;30(9):1146-51. https://doi.org/10.1111/ctr.12803. https://doi.org/10.1111/ctr.12803... ) (n=56) LDLT	Mean age 51.1±8.7;15 male and 2 female; MELD score 17.1±7.3; CTP score 9.5±2.4	Yerdel I (n=17)	17 Thrombectomy	-2 patients with graft rejection -The survival didn’t differed of no -PVT group
	Mean age 51.2±8.3;22 male and 4 female; MELD score 19.0±7.4; CTP score 9.7±1.8	Yerdel II (n=26)	26 Thrombectomy	-2 patients with graft rejection -The survival didn’t differed of no -PVT group
	Mean age 52.1±10.9;9 male and 2 female; MELD score 20.9±9.2; CTP score 11.0±2.0	Yerdel III (n=11)	11 Thrombectomy	-The survival didn’t differed of no -PVT group
	Mean age 51.5±3.5;2 male;MELD score 22.0±15.5; CTP score 9.5±2.1	Yerdel IV (n=2)	1 Thrombectomy1 Jumpgraft SMV	-The 2 patients died until 1 year after LT
Hernandez-Conde et al. (¹⁷17. Hernández-Conde M, Llop Herrera E, de la Revilla Negro J, Pons Renedo F, Fernández Puga N, Martínez-Porras JL, et al. Prevalence and outcome of portal thrombosis in a cohort of cirrhotic patients undergoing liver transplantation. Rev Esp Enferm Dig. 2016;108(11):716-20.) 2016 (n=18) DDLT	Mean age 53±5;14 male;MELD score 16.5±4.7 22.0±15.5; CTP 7 grade A, 8 grade B; 2 grade C; Main etiology was VHC with 9 patients	Yerdel I (n=12Y )erdel II (n=3) Yerdel III (n=3)	18 Thrombectomy	The 30-day mortality was higher in PVT patients

[1] *Corresponding author. E-mail: lucasnacif@usp.br

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Portal vein surgical treatment on non-tumoral portal vein thrombosis in liver transplantation: Systematic Review and Meta-Analysis