Obesity is an independent risk factor for pre-transplant portal vein thrombosis in liver recipients

Abstract

BackgroundPortal vein thrombosis is a frequent complication in end-stage cirrhosis with a considerable peri-operative risk for liver transplant candidates. We aimed to characterize the pre-transplant portal vein thrombosis in a cohort of liver transplant recipients, and to identify independent risk factors for this complication.Methods380 consecutive primary orthotopic liver transplants were performed in the Digestive Surgery Department of “12 de Octubre” Hospital (Madrid, Spain), between January 2001 and December 2006. The main risk factors considered were smoking, obesity, metabolic disorders, previous immobility, surgery or trauma, nephrotic syndrome, associated tumor, inflammatory disease, neoplasm myeloprolipherative. Furthermore we have reported genetic thrombophilia results for 271 recipients.ResultsSixty-two (16.3%) patients developed pre-transplant portal vein thrombosis and its presence had no impact in the overall survival of liver recipients. Obesity was the only independent risk factor for pre-transplant portal vein thrombosis.ConclusionWe recommend close control of cardiovascular factors in patients with liver cirrhosis in order to avoid associated thrombosis.

Portal Vein Thrombosis Is a Risk Factor for Poor Early Outcomes After Liver Transplantation

“…A diagnosis of fatty liver or cryptogenic liver disease was associated with the highest OR of PVT (1.5), and lends support to the suggested association of fatty liver and obesity with increased thrombotic risk. [17][18][19] These same risk factors were also associated with presence of PVT at listing, lending further credibility to their association with risk for PVT. Ascites was also associated with risk of "new" PVT, which concurs with the association of increased risk of PVT with lower portal flow in the setting of more severe portal hypertension.…”

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

“…Multiple studies report conflicting results in terms of the presence of PVT and posttransplant outcomes. However, many of these studies are plagued with heterogeneous study populations, with much of the literature including recipients transplanted for primary liver tumors in their population . We excluded these patients in our population to avoid any potential bias of HCC or cholangiocarcinoma.…”

“…Indeed, an association between NASH and portal vein thrombosis (PVT) is illustrated in the literature, with an increased risk of PVT in NASH patients with cirrhosis presenting for LT . Similarly, obesity is a well‐known risk factor for vascular thrombosis, and along with diabetes, it has been shown to be an independent risk factor for the development of pretransplant PVT among LT recipients …”

Portomesenteric venous thrombosis following major colon and rectal surgery: incidence and risk factors

“…Patients in the PMVT group had higher BMI comparatively, though averages in both groups were overweight. Obesity has recently been observed as an independent risk factor for PV thrombosis in the pre-transplant population, and in our study it remained the only modifiable risk factor associated with PMVT [21]. In this review, UC did not persist as an independent risk factor for PMVT.…”

“…Systemic factors include inherited prothrombotic states (antithrombin III deficiency, factor V Leiden mutation, protein C and S deficiency, and G20210A prothrombin mutation) and acquired prothrombotic states (sepsis, oral contraceptive use, and MPN) [11,20]. Patients with cirrhosis and hepatic carcinoma are suggested to have the highest risk of PMVT development while obesity and surgical intervention have also been shown to increase prothrombotic risk [3,16,[20][21][22][23]. Certain surgical procedures are shown to have a higher PMVT incidence, particularly proctocolectomy and splenectomy, where extensive manipulation of mesenteric vessels and ligation of the splenic vein increase overall PMVT risk [23] [24].…”