Diffuse splanchnic venous thrombosis (DSVT), formerly defined as contraindication for liver transplantation (LT), is a serious\nchallenge to the liver transplant surgeon. Portal vein arterialisation, cavoportal hemitransposition and renoportal anastomosis,\nand finally combined liver and small bowel transplantation are all possible alternatives to deal with this condition. Five patients\nwith preoperatively confirmed extensive splanchnic venous thrombosis were transplanted using cavoportal hemitransposition\n(4x) and renoportal anastomosis (1x). Median follow-up was 58 months (range: 0,5 to 130 months). Two patients with previous\nradiation-induced peritoneal injury died, respectively, 18 days and 2 months after transplantation. The three other patients\nhad excellent long-term survival, despite the fact that two of them needed a surgical reintervention for severe gastrointestinal\nbleeding. Extensive splanchnic venous thrombosis is no longer an absolute contraindication to liver transplantation. Although\ncavoportal hemitransposition and renoportal anastomosis undoubtedly are life-saving procedures allowing for ensuring adequate\nallograft portal flow, careful follow-up of these patients remains necessary as both methods are unable to completely eliminate the\ncomplications of (segmental) portal hypertension.
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