[Vascular pathology of the portal vein distal branches: a rare cause of liver transplantation and a protean clinical presentation].

We report 5 cases of liver transplantation which showed phlebosclerotic lesions of the distal portal vein on the explant confirming a diagnosis of hepatoportal sclerosis. This lesion was associated with nodular regenerative hyperplasia (2 cases), incomplete septal cirrhosis (4 cases) and tumors (2 cases, 1 adenoma and 1 hepatocellular carcinoma). Indications for transplant were chronic liver failure (1 case), encephalopathy without liver insufficiency (2 cases), an adenoma (1 case), a liver mass (1 case). Three patients out of 5 had a past history of surgical portacaval shunts to treat variceal bleeding non related to cirrhosis, one had a spontaneous portacaval shunt, and 2 had undergone a splenectomy for pancytopenia. The review of liver biopsies (4 cases out of 5) performed during surgery showed distal portal vein phlebosclerotic lesions. The diagnosis of hepatoportal sclerosis associated with complications, which is obvious retrospectively, is seldom made prior to transplantation. Portacaval shunts could play at least a partial role in the progressive deterioration of the liver.