Clinical Impact of Portal Vein Thrombosis Prior to Liver Transplantation: A Retrospective Cohort Study

Karvellas, Constantine; Cardoso, Filipe S.; Senzolo, Marco; Wells, Malcolm; Handou, Fayaz; Kwapisz, Lukasz; Kneteman, Norman M.; Marotta, Paul; Al-Judaıbı, Bandar

doi:10.5604/16652681.1231584

Cited by 23 publications

(26 citation statements)

References 28 publications

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“…HCV infection, alcohol abuse, and fatty liver disease are the major risk factors associated with the development of the disease. These findings corroborate other studies [3,5,19,20].…”

Section: Discussionsupporting

confidence: 83%

“…The serological marker most often used is AFP and diagnostic imaging has been an important instrument to detect lesions in the subclinical stage [3,20]. In the present study, we found serum AFP levels below 400 ng/mL more often at the time HCC diagnosis was performed.…”

Section: Discussionsupporting

confidence: 60%

“…Heterogeneity in the worldwide incidence reflects variations in the distribution of the main risk factors [3]. In the present study, the diagnosis of HCC was more frequent in male patients with a mean age of 61 years.…”

Section: Discussionmentioning

confidence: 58%

“…In Brazil, the incidence of HCC ranges from 3.3 to 6.0% per 1,00,000 persons per year, and this rate is similar to mortality rates, due to the high levels of intrahepatic recurrence, distant metastasis, and the lack of effective treatment for the cas- es diagnosed at an advanced stage [2,3]. Brazilian data indicate greater HCC prevalence in men aged over 50 years, with cirrhosis and infection by hepatitis C virus (HCV) [3]. Most cases are diagnosed in South and Southeast regions, especially in the state of Rio Grande do Sul, where the incidence of HCC is higher than 5 cases/1,00,000 inhabitants [4].…”

Section: Introductionmentioning

confidence: 90%

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Sorafenib for Advanced Hepatocellular Carcinoma: A Real-Life Experience

Longo

Freitas

Santos

et al. 2018

Dig Dis

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Introduction: Sorafenib (SOR) has proved to be effective in patients with advanced hepatocellular carcinoma (HCC), since overall survival was higher in phase III clinical trials; however, disease progression can occur. Objectives: The study aimed to describe real-life experience in advanced HCC treatment with SOR at a university hospital in Brazil and to estimate the number of patients with indication of second-line therapy. Methods: This is a retrospective study that included cases of HCC with prescription of SOR based on real-life practice between 2011 and 2016. Demographic, clinical, and laboratory data were collected. Results: From 572 patients with HCC, SOR was prescribed in 103 cases. From them, 62.1% were classified as Child-Pugh (CP)-A, 54.4% as Barcelona Clinic Liver Cancer (BCLC)-C, and 74 (71.8%) started treatment. Overall survival was 25.5 (95% CI 17.0–34.1) months and 1-year survival was greater in patients who received SOR than in non-treated (88.7 vs. 44.4%, p < 0.001). There was no difference in survival between BCLC-B and C (p = 0.405), as well as CP-A and B (p = 0.919). In 21.6% of the patients, a second-line therapy with regorafenib was indicated. Conclusion: In this real-life study, SOR significantly increased the survival rate by 1 year in patients with advanced HCC regardless of BCLC staging and CP score. Second-line therapy would be indicated in 21.6% of cases.

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“…HCV infection, alcohol abuse, and fatty liver disease are the major risk factors associated with the development of the disease. These findings corroborate other studies [3,5,19,20].…”

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 90%

See 2 more Smart Citations

Sorafenib for Advanced Hepatocellular Carcinoma: A Real-Life Experience

Longo

Freitas

Santos

et al. 2018

Dig Dis

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“…In line with our results, Ghabril et al reported that patients with PVT on organ procurement and transplant network (OPTN) are more susceptible to early adverse events including higher mortality after liver transplantation . In a retrospective cohort, occlusive PVT was associated with increased early posttransplant mortality …”

Section: Discussionmentioning

confidence: 99%

Portal vein thrombosis in patients with liver cirrhosis and its impact on early and long‐term outcomes after liver transplantation

et al. 2019

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Summary Aim Portal vein thrombosis (PVT) is a common complication amongst patients with liver cirrhosis. The PVT risk factors and its impact on post liver transplant outcome has not been well defined, yet. This study aimed to investigate PVT prevalence, its risk factors and influence on early and long‐term outcomes after liver transplantation. Methods Adult (>18 years) patients with liver cirrhosis undergoing liver transplantation between March 2013 to March 2015 were included. Presence or absence of PVT was recorded at transplant. PVT risk factors in patients with liver cirrhosis and its impact on early and long‐term outcomes were analysed. Results Portal vein thrombosis was diagnosed in 174 patients (17.3%). Large oesophageal varices (grade II and III vs grade I) (OR: 2.5; 95% CI: 1.46‐4.26; P = 0.001), diabetes mellitus before transplantation (OR: 2.03; 95% CI: 1.13‐3.64; P = 0.017) and cryptogenic‐NASH (OR: 1.36; 95% CI: 1.08‐1.72; P = 0.008) as a cause of underlying liver disease were the independent risk factors for PVT. PVT (OR: 2.05; 95% CI: 1.10‐3.81; P = 0.023) was an independent predictor of early (within 90 days) posttransplant mortality, but did not influence long‐term survival. Conclusion Portal vein thrombosis prevalence is high in pretransplant period. NASH related cirrhosis and diabetes mellitus might be risk factors for PVT. More intense screening of these patients for PVT is warranted.

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Impact of Nonmalignant Portal Vein Thrombosis in Transplant Recipients With Nonalcoholic Steatohepatitis

Agbim

Jiang²,

Kedia³

et al. 2019

Liver Transpl

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Nonalcoholic fatty liver disease (NAFLD) is an increasingly prevalent condition and its more severe progressive state, nonalcoholic steatohepatitis (NASH), is currently the second most common indication for waitlisted adults in the United States. The association of portal vein thrombosis (PVT) prior to or at transplant and poor graft and patient outcomes is not well established, particularly among NASH patients who inherently have an increased hypercoagulable profile. Using the United Network for Organ Sharing dataset, we analyzed graft and patient outcomes of patients transplanted for the indication of NASH with and without PVT. Of 3,689 NASH transplant recipients, the prevalence of PVT was 12% (450 with PVT and 3,239 without PVT). NASH transplant recipients with PVT had inferior graft and patient survival compared to NASH transplant recipients without PVT, even after adjusting for recipient and donor demographic characteristics, body mass index (BMI), synthetic dysfunction, and presence of diabetes. In a multivariate Cox regression model, NASH transplant recipients with PVT had a 37% increased risk of graft failure (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.15-1.63; P < 0.001) and 31% increased risk of overall death (HR, 1.31; 95% CI, 1.09-1.58; P < 0.001) compared with NASH transplant recipients without PVT at transplant. This difference in graft and patient survival was most pronounced in the early post-transplant period. These results demonstrate NASH patients with PVT have decreased graft and patient survival independent of recipient and donor factors. This article is protected by copyright. All rights reserved.

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Clinical Impact of Portal Vein Thrombosis Prior to Liver Transplantation: A Retrospective Cohort Study

Abstract: Patients with HCC were mainly older men diagnosed at an advanced stage. Treatment was associated with better overall survival, but few patients survived to be treated.

Cited by 23 publications

References 28 publications

Sorafenib for Advanced Hepatocellular Carcinoma: A Real-Life Experience

Sorafenib for Advanced Hepatocellular Carcinoma: A Real-Life Experience

Portal vein thrombosis in patients with liver cirrhosis and its impact on early and long‐term outcomes after liver transplantation

Impact of Nonmalignant Portal Vein Thrombosis in Transplant Recipients With Nonalcoholic Steatohepatitis

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