A Novel Preoperative Classification System for Selecting Suitable Surgeries in Liver Transplant Patients with Portal Vein Cavernous Transformation.

Background: To evaluate the new preoperative Changgung classification (CC) system of portal vein thrombosis (PVT) in choosing suitable operative procedures to reconstruct portal veins during liver transplantation (LT) in patients with portal vein cavernous transformation (PVCT).

Methods: This retrospective observational study analyzed data from allograft LTs performed for various liver diseases.

Results: The study included 22 males and 4 females with LT indications comprising cirrhosis ( = 9), hepatocellular carcinoma ( = 12), PVCT ( = 2), liver failure from fulminant hepatitis B ( = 1), dysfunction of transplanted liver ( = 1), and chronic rejection of transplanted liver ( = 1).

Modified Meso-Rex bypass with umbilical vein recanalization and intra-operative stenting.

Purpose: The aim of the study was to evaluate the usefulness of a novel modified Meso-Rex bypass surgical technique with umbilical vein recanalization and intra-operative stenting to treat portal vein cavernous transformation.

Methods: In total, 13 portal vein cavernous transformation patients underwent Meso-Rex bypass surgery, consisting of bypass grafts between the superior mesenteric vein (SMV) and the recess of Rex as well as through the ligamentum teres hepatis without stent implantation (Group A, n = 9) and umbilical vein recanalization with intra-operative stent implantation (Group B, n = 4).

Results: In Group A, the bypass diameter was 0-6 mm (median 3 mm) and blood flow velocity 25-115 cm/s (median 72 cm/s) 1 month after Meso-Rex bypass surgery, with open bypass times of 0-67 months (median 6 months); 6 patients in this group developed postoperative Meso-Rex bypass occlusions.