SIR 2026

Educational Exhibit

Transplant Interventions

Session: Educational Exhibit Presentations - Portal hypertension/Transplant/GI

Portal Vein Thrombosis in Liver Transplant Candidates: Interventional Strategies and Teaching for the Modern IR

Monday, April 13, 2026

5:03 PM - 5:09 PM ET

Location: 718B

Abstract Presenter(s)

Millennie Chen

Medical Student
UC Riverside School of Medicine, United States

Author/Co-author(s)

Harneet Sangha

Medical Student
Elson S Floyd College of Medicine, United States
MM

Manvir Mangat, BS

Medical Student
Western University of Health Sciences, United States
LL

Lauren Lee, BS

Medical Student
Elson S Floyd College of Medicine, United States
GC

Gabrielle Cua, BS

Medical Student
Elson S Floyd College of Medicine, United States
LS

Lakhwant Singh, DO

Interventional Radiologist
Sounds Imaging, United States

Learning Objectives:

Review the incidence, risk factors, and clinical implications of portal vein thrombosis (PVT) in cirrhotic patients being evaluated for liver transplantation.

Understand the technical aspects and evolving role of portal vein recanalization–TIPS (PVR-TIPS) in restoring physiologic portal inflow prior to transplant.

Identify complication management strategies and multidisciplinary considerations essential for optimizing outcomes in this complex patient cohort.

Background: Portal vein thrombosis occurs in up to 26% of decompensated cirrhotic patients awaiting transplantation and historically limited surgical candidacy. Advances in interventional radiology have shifted management, with PVR-TIPS emerging as a cornerstone technique to recanalize thrombosed portal veins, facilitate physiologic anastomoses, and reduce post-transplant morbidity. Understanding classification systems, appropriate patient selection, and technical strategies are essential for interventional radiologists caring for this high-risk population.

Clinical Findings/Procedure Details:

Review common classification schemes of PVT (Yerdel, Jamieson, Charco) and their impact on transplant decision-making.

Illustrate step-wise procedural details of PVR-TIPS, including role of transjugular, transplenic, and transmesenteric approaches, supported by imaging examples.

Discuss technical pearls such as wire/catheter selection, “gun-sight” techniques for recanalization, and strategies to maximize portal patency while preserving surgical options.

Present evidence on outcomes: success rates of 95–98% with sustained patency, and high rates of physiologic anastomosis in transplant recipients

Conclusion and/or Teaching Points: PVT remains a major barrier in liver transplantation, but advances in interventional techniques — particularly PVR-TIPS — allow restoration of portal inflow and expand transplant candidacy. Mastery of classification systems, procedural strategies, and multidisciplinary coordination equips interventional radiologists to optimize peri-transplant outcomes. Ongoing education, research, and dissemination of technical pearls are vital as this field continues to evolve.