Introduction : Complete occluded portal vein thrombosis (PVT) is not any more contraindication of liver transplantation since many innovative surgical techniques have been introduced, such as surgical or endovascular thrombectomy, vascular stenting, portal vein patch, venous jump grafts, cavoportal hemitransposition. When PVT has reached to (grade 4) which is the thrombosis involving the proximal superior mesenteric vein (SMV), splenic vein (SV) and the main portal vein (MPV). It’s making more difficulty to reconstruct the donor and recipient PV.

Methods :

Results : We are describing our experience on the LDLT surgical approach for a patients suffered from uncompensated liver cirrhosis with portal hypertension complicated by difficult controllable bleeding of esophageal varices due to chronically progressive and extensive thrombosis causing complete occluded of the portal vein (grade 4), which successfully managed with transsplenic endovascular access (4 French) for PV recanalization, thromectomy, stent-angioplasty and then portal patch using either native recipient portal vein or cryopreserved cadaveric vessels to ensure a proper portal alignment and flow with graft PV. Also, we are doing an intra-operative portography (IOP) to interrupt any sizable collaterals. The postoperative follow up showed good portal flow to the graft.

Conclusions : LDLT for completely occluded PVT is adding a more challenging and morbidity in the recipient and need special surgical approach to overcome the difficulty for restoring the anatomical flow of PV. High volume transplant center and multidisciplinary approaches including surgical correction of PVT, intra-operative portography (IOP), and interruption of sizable collaterals are necessary to decreased PVT-related complications and showed acceptable results despite the severity of PVT.