Liver transplant recipients with portal vein thrombosis receiving an organ from a high-risk donor are at an increased risk for graft loss due to hepatic artery thrombosis

Abstract

Problem We hypothesize that recipients with pre-transplant portal vein thrombosis (PVT) receiving organs from high-risk donors (HRD) are at increased risk of HAT. Methods Data on all liver transplants in the United States from February 2002-March 2015 were analyzed. Recipients were sorted into two groups: those with PVT and those without. HRDs were defined by Donor Risk Index (DRI) >1.7. Multivariable logistic regression models were constructed to assess independent risk factors for HAT with resultant graft loss ≤90 days from transplantation. Results 60,404 candidates underwent liver transplantation; of those recipients, 623 (1.0%) had HAT, of which 66.0% (n=411) received organs from HRDs compared to 49.3% (n=29,473) in recipients without HAT (p<0.001). 2,250 (3.7%) recipients had pre-transplantation PVT and received organs from HRDs. On adjusted multivariable analysis, PVT with a HRD organ was the most significant independent risk factor (OR 3.56, 95% CI 2.52–5.02, p<0.001) for the development of HAT. Conclusions Candidates with pre-transplant PVT who receive an organ from a HRD are at the highest risk for post-operative HAT independent of other measurable factors. Recipients with pre-transplant PVT would benefit from careful donor selection and possibly anticoagulation perioperatively.

Development of a Model to Predict Portal Vein Thrombosis in Liver Transplant Candidates: The Portal Vein Thrombosis Risk Index

“…Villa et al previously demonstrated that prophylactic administration of low‐molecular‐weight heparin for 12 months prevented the development of de novo PVT in patients with compensated cirrhosis with an associated reduction in mortality and hepatic decompensation in the absence of any clinically relevant bleeding events. Our findings reinforce the importance of this study as preventing the development of PVT is of great interest, especially given the link between pretransplantation PVT and early hepatic artery thrombosis with its high morbidity and mortality within 90 days following liver transplantation . It is plausible that by using the PVT‐RI prospectively to identify those patients at greatest risk for developing PVT, future therapeutic studies could be developed to offer the most clinical utility and benefit to patient outcomes.…”

“…Our findings reinforce the importance of this study as preventing the development of PVT is of great interest, especially given the link between pretransplantation PVT and early hepatic artery thrombosis with its high morbidity and mortality within 90 days following liver transplantation. (26,27) It is plausible that by using the PVT-RI prospectively to identify those patients at greatest risk for developing PVT, future therapeutic studies could be developed to offer the most clinical utility and benefit to patient outcomes. Furthermore, identifying the group of liver transplant candidates at greatest risk for PVT development may offer an avenue for improved screening and surveillance practices.…”

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

“…The impact of donor factors is significant as riskier donor factors are associated with higher morbidity in transplant recipients. For example, there is an increased risk of HAT in recipients with PVT transplanted with organs from donors with a DRI > 1.7 . DRI was no longer significant when examining overall deaths in the Cox regression model, representing the role of retransplantation and subsequent patient survival.…”

The donor risk index: A decade of experience

“…For example, use of high‐risk donor livers (DRI ≥ 1.7) was associated with a significant increase in relative risk of allograft failure in each MELD category. In addition, the DRI was an independent predictor of development of complications (hepatic artery thrombosis, biliary complications, end‐stage renal disease), morbidity (increased cost of care and readmissions), progression of fibrosis among patients with HCV, and survival in selected subsets, such as those undergoing transplantation for hepatocellular carcinoma (HCC) as well as those undergoing retransplantation …”