Management of Thrombosis in the Liver Transplant Candidate

Zanetto, Alberto; Senzolo, Marco

doi:10.1007/978-3-319-92934-7_8

Cited by 2 publications

(5 citation statements)

References 142 publications

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“…The prevalence of deep vein thrombosis (DVT) and pulmonary thromboembolism in hospitalized patients with cirrhosis is estimated at 1–7% 75 . Prolongation of INR does not reflect the coagulation imbalance in cirrhosis and does not prevent the development of VTE 76 .…”

Section: Thrombotic Complications In Patients With Cirrhosis and Hccmentioning

confidence: 99%

Haemostatic alterations in patients with cirrhosis and hepatocellular carcinoma: laboratory evidence and clinical implications

Zanetto

Campello

Pelizzaro

et al. 2022

Liver International

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Venous thrombosis is a frequent complication in cancer and is associated with high morbidity and mortality. Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer‐related death worldwide, and it is associated with preexisting cirrhosis in 90% of cases. Patients with cirrhosis acquire complex alterations in their haemostatic system that may predispose them to bleed or thrombotic complications. There is growing evidence that HCC may tilt the haemostatic equilibrium in cirrhosis towards hypercoagulability, thus increasing the risk of venous thrombosis. Previously described mechanisms of HCC‐driven thrombophilia include thrombocytosis and increased platelet activation/function, increased fibrinogen concentration/polymerization, enhanced thrombin generation, hypofibrinolysis, and release of tissue factor‐expressing microvesicles. Nevertheless, there are currently no specific guidelines on risk stratification and management of thromboprophylaxis in patients with cirrhosis and HCC. Our review endeavours to summarize the latest findings on epidemiology, risk factors and pathogenesis of non‐malignant venous thrombosis in patients with cirrhosis and HCC, and provide evidence in support of tailored management of thrombotic risk in these patients.

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Section: Thrombotic Complications In Patients With Cirrhosis and Hccmentioning

confidence: 99%

Haemostatic alterations in patients with cirrhosis and hepatocellular carcinoma: laboratory evidence and clinical implications

Zanetto

Campello

Pelizzaro

et al. 2022

Liver International

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“…In 1976, the first liver transplantation (LT) was performed for the treatment of end‐stage liver disease in a young woman with sub‐acute BCS due to hormonal therapy, with favourable outcome. Twelve years later, Campbell reported the first case series including 17 liver transplant recipients . During a follow‐up of 28 months, the survival rate was 88%.…”

Section: Introductionmentioning

confidence: 99%

“…During a follow‐up of 7 years, the others remained in good clinical condition and none of them developed hepatic encephalopathy. Recently, Orloff published an updated description of his single‐centre experience, and confirmed the first results: among 60 patients who underwent SPSS from 1972 to 1999, long‐term survival rate was higher than 90%, with complete resolution of ascites and no severe side effects …”

Section: Introductionmentioning

confidence: 99%

“…The use of bare stents was associated with a high risk of shunt thrombosis/failure and multiple revisions were needed during the follow‐up. The issue was solved with the development of polytetrafluoroethylene‐covered stent, which ensured a patency rate up to 70% at 1 year . In a recent multicenter study, TIPS was not only able to achieve the resolution of symptoms, but also to improve 5‐year survival (up to 71%) in high‐risk patients not responding to anticoagulant treatment.…”

Section: Introductionmentioning

confidence: 99%

“…To date, 12 major case series including 316 patients in total have been reported. Overall, 5‐year‐survival rates range between 50% (in the older series) and 98% (in the more recent series) …”

Section: Introductionmentioning

confidence: 99%

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Milestones in the discovery of Budd‐Chiari syndrome

Zanetto

Pellone

Senzolo

2019

Liver International

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In 1845, George Budd published a brief report regarding three patients who developed an obstruction of the hepatic veins. The condition has never been reported before, and was related to sepsis and alcoholism. Fifty-three years later, Hans Chiari postulated that syphilis was causing the obstruction of the hepatic veins, and enriched the debate with clinical and pathological correlations. Following the hypothesis on the 'phlebitis obliterans', several authors proposed other pathophysiological explanations including congenital causes, chronic trauma and exogenous toxins. RG Parker, in 1959, first recognized the relationship between obstruction of hepatic veins and thrombophilic conditions such as polycythaemia vera, pregnancy and hormonal therapy. Based on that, anticoagulant treatment was attempted, but with unsatisfactory outcome. We need to wait until the mid 1980s to see a widespread adoption of anticoagulants, with a consequent improvement of patients' survival. The fear of haemorrhagic events in patients with liver disease discouraged this therapeutic approach, and other surgical interventions (mainly port-systemic shunts) were conceived, but with high morbidity and mortality. The first liver transplantation in 1976 and the first trans-jugular intra-hepatic porto-systemic shunt in 1993 represented two major cornerstones in the management of Budd-Chiari syndrome (BCS).Such progresses allowed modifying the treatment of BCS until the modern concept of stepwise therapy. The present review thoroughly reviews the major landmarks in the discovery, treatment and clinical management of patients with BCS.

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Management of Thrombosis in the Liver Transplant Candidate

Cited by 2 publications

References 142 publications

Haemostatic alterations in patients with cirrhosis and hepatocellular carcinoma: laboratory evidence and clinical implications

Haemostatic alterations in patients with cirrhosis and hepatocellular carcinoma: laboratory evidence and clinical implications

Milestones in the discovery of Budd‐Chiari syndrome

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