Glue Embolus-Induced Portosplenic Thrombosis in Transjugular Intrahepatic Portosystemic Shunt: A Novel Finding During Liver Transplantation.

BACKGROUND Portal vein thrombosis (PVT) in patients with cirrhosis is a significant challenge to liver transplantation and increases post-transplant morbidity and mortality, requiring advanced surgical techniques that include thrombectomy, venous grafts, and anticoagulation. This report describes the case of a 62-year-old woman with liver cirrhosis and portal systemic thrombosis within the transjugular intrahepatic portosystemic shunt (TIPS) prior to orthotopic liver transplantation (OLT), and with portal vein glue embolization in the explanted liver. CASE REPORT Our patient was diagnosed with cirrhosis 2 years prior to OLT, which was complicated by gastric varices. She subsequently underwent glue embolization of varices and TIPS placement 1 year prior to OLT. Four months prior to OLT, she was admitted to the hospital for sepsis evaluation. Computed tomography angiography (CTA) revealed a thrombus extending from the TIPS to the cavo-atrial junction. A concurrent portal vein thrombus was seen extending into the splenic vein. This led to a thrombectomy procedure, with follow-up CTA revealing a small amount of residual thrombus within TIPS. She was transferred to our institution for an OLT. We present a novel case that involved successful OLT along with TIPS removal and mechanical thrombectomy. Cirrhotic patients pose a challenge during liver transplantation due to their rebalanced and unstable coagulation state. CONCLUSIONS Portosplenic thrombosis in patients with cirrhosis was previously noted to be a barrier to liver transplantation. This report shows that liver transplant can be successful with multidisciplinary preoperative and postoperative surgical and medical management.