“The World’s First”: Sequential Success of Thrombectomy Followed by Liver Transplant at Severance Hospital

In a groundbreaking first, a patient previously deemed unfit for transplant due to a portal vein blocked by a thrombus (blood clot) has successfully undergone liver transplant surgery following a thrombectomy. This marks the first instance worldwide of such a sequence being successful.

Professors Lee Jae-keun and Min Eun-ki from the Department of Transplant Surgery at Severance Hospital, along with Professor Han Ki-chang from the Department of Interventional Radiology, announced on the 2nd that the transplant surgery was successfully completed for Mr. Jung Min-soo, 47, a patient with cirrhosis, after removing the thrombus that had obstructed the portal vein necessary for the operation.

Mr. Jung had cirrhosis so severe that medication was no longer an option. Cirrhosis develops as liver cells become inflamed, and the normal cells are destroyed in recurring cycles. With no possibility of the liver reverting to its normal state, transplantation remains the only treatment.

Initially, Mr. Jung was rejected for a liver transplant at Severance Hospital because his portal vein, essential for connecting the donor liver’s vein to the recipient’s, was obstructed by a thrombus. The portal vein carries nutrient-rich blood from the gastrointestinal tract to the liver, formed by the convergence of the superior mesenteric vein, which supplies blood and nutrients from the intestine, and the splenic vein from the spleen.

Professor Lee considered connecting the superior mesenteric vein and the transplant liver's portal vein, but this, too, was blocked by a thrombus, as was the splenic vein. The spleen had enlarged to more than twice its normal size, measuring 26 cm.

Before proceeding with the transplant, Professor Lee requested collaboration from Professor Han, who decided first to remove the thrombus obstructing the portal vein by performing a TIPS (Transjugular Intrahepatic Portosystemic Shunt) procedure. 

TIPS involves inserting a metallic mesh tube, or stent, to create a tunnel (shunt) that clears the blocked vessel. Professor Han had previously performed multiple TIPS procedures when portal vein thrombosis occurred in liver transplant recipients.

Professor Han successfully removed thrombi from the portal and superior mesenteric valves over three hours. Subsequently, Professor Lee connected Mr. Jung’s portal vein to that of the donor's liver and completed the transplant surgery. The enlarged spleen was also removed during the operation.

Until now, there had been no instances globally where a thrombectomy followed by a liver transplant was successfully carried out sequentially. The technical complexity lies in connecting a stented state of the portal vein to the transplant liver’s vein.

The surgeries were particularly challenging, necessitating not only the removal of the portal and superior mesenteric vein thrombi but also the removal of the spleen.

Six months after the liver transplant, Mr. Jung was discharged and returned to his daily life.

Professor Lee stated, "Many patients whose portal and superior mesenteric veins are blocked by thrombi are unable to proceed with transplantation and succumb to their conditions. We expect collaboration with the Department of Interventional Radiology and progressing with TIPS will broaden the opportunities for liver transplants."

Meanwhile, the Liver Transplant Team at the Severance Hospital Organ Transplant Center continues to offer hope to patients requiring liver transplants by successfully conducting high-complex surgeries for patients with polycystic liver disease and advanced liver cancer.