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

Ghabril, Marwan; Agarwal, Saurabh; Lacerda, Marco A.; Chalasani, Naga; Kwo, Paul Y.; Tector, A. Joseph

doi:10.1097/tp.0000000000000785

Cited by 131 publications

(48 citation statements)

References 18 publications

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“…Also other series reported a significant higher first 3 months perioperative mortality and graft failure in patients with pre-existing PVT mainly in patients with extensive PVT [24,25].…”

Section: Discussionmentioning

confidence: 87%

Living Donor Liver Transplantation for Patients with Pre-existent Portal Vein Thrombosis

Zakaria¹,

Taha²,

Gad³

et al. 2017

J Liver

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Background: Portal vein thrombosis (PVT) in living donor liver transplantation (LDLT) is a surgical challenge with technical difficulty. The aim of this study was to analyze the operative planning for management of PVT in LDLT and the impact of PVT on the outcome in comparison to patients without PVT. Methods: Between July 2003 to August 2016, 213 patients underwent LDLT. The patients were divided into two groups with and without PVT. The preoperative, operative, and postoperative data were analysed. Results: Thirty six patients (16.9%) had different grades of PVT at time of liver transplantation (LT); grades I, II, III and IV were 18 (50%), 14 (38.9%), 3 (8.3%) and 1 patient (2.8%) respectively. The management of PVT was by; thrombectomy in 31 patients (86%), bypass graft in 2 patients (5.6%), portal replacement graft in 1 patient (2.8%), anastomosis with the left renal vein in 1 patient (2.8%) and with large collateral vein in 1 patient (2.8%). Overall postoperative PVT occurred in 10 patients (4.7%), 4 patients of them had preoperative PVT. The perioperative mortality in patients with PVT, and patients without PVT was 33.3%, and 20.3%, respectively (P=0.17). The 1-, 3-, 5-, and 7y survival in patients with PVT was 49.7%, 46.2%, 46.2%, 46.2% respectively and in patients without PVT it was 65%, 53.7%, 50.8%, 49% respectively (P=0.29). Conclusions: Preoperative PVT may not keep a patient from undergoing successful LT with comparable outcome to patients without PVT specially with partial PVT.

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“…Also other series reported a significant higher first 3 months perioperative mortality and graft failure in patients with pre-existing PVT mainly in patients with extensive PVT [24,25].…”

Section: Discussionmentioning

confidence: 87%

Living Donor Liver Transplantation for Patients with Pre-existent Portal Vein Thrombosis

Zakaria¹,

Taha²,

Gad³

et al. 2017

J Liver

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“…Even though PVT is no longer considered a contraindication in LT [5, 6], it remains a risk factor associated with posttransplant morbidity and mortality, directly affecting graft patency [10–14]. Technical difficulties increase surgery time and lead to severe bleeding; inadequate blood flow may result in graft disfunction or loss and rethrombosis [3, 12, 13, 15–20]. …”

Section: Discussionmentioning

confidence: 99%

Use of Left Gastric Vein as an Alternative for Portal Flow Reconstruction in Liver Transplantation

Teixeira

Machry

Goldoni

et al. 2016

Case Reports in Surgery

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Portal vein thrombosis is observed in up to 10% of liver transplant candidates, hindering execution of the procedure. A dilated gastric vein is an alternative to portal vein reconstruction and decompression of splanchnic bed. We present two cases of patients with portal cavernoma and dilated left gastric vein draining splanchnic bed who underwent liver transplantation. The vein was dissected and sectioned near the cardia; the proximal segment was ligated with suture and the distal segment was anastomosed to the donor portal vein. Gastroportal anastomosis is an excellent option for portal reconstruction in the presence of thrombosis or hypoplasia. It allows an adequate splanchnic drainage and direction of hepatotrophic factors to the graft.

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“…PVT in patients with cirrhosis has been shown to have little influence on the course of liver disease, except for patients with PVT at liver transplantation in whom 90-day mortality and graft failure have been reported to be higher than in those without PVT [10,11]. Moreover, non-progression or resolution has been reported in up to 75% of patients.…”

Section: Definitions and Classificationmentioning

confidence: 99%

“…Extensive PVT has been shown to be associated with higher mortality after liver transplantation, while incidentally discovered PVT during liver transplantation did not affect mortality [67,70]. However, studies found that complete PVT impacts short-term survival (3 months to 1 year), whereas long-term survival does not differ between PVT and non-PVT groups [41,71,72]. This effect might be due to the surgical techniques available for portal anastomosis depending on the extent of PVT.…”

Section: Prognosismentioning

confidence: 99%

Portal vein thrombosis in patients with cirrhosis

Köckritz

Gottardi

Trebicka

et al. 2017

Gastroenterology Report

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Portal vein thrombosis (PVT) is frequent in patients with liver cirrhosis and possible severe complications such as mesenteric ischemia are rare, but can be life-threatening. However, different aspects of clinical relevance, diagnosis and management of PVT are still areas of uncertainty and investigation in international guidelines. In this article, we elaborate on PVT classification, geographical differences in clinical presentation and standards of diagnosis, and briefly on the current pathophysiological understanding and risk factors. This review considers and highlights the pitfalls of the various treatment approaches and prophylactic treatments. Finally, we review the controversial issue of clinical impact of PVT on prognosis, especially considering liver transplantation and future perspectives.

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

Abstract: Portal vein thrombosis at LT is associated with early (90 days) mortality and graft failure, though a likely but undefined reporting bias for more extensive PVT would overstate estimated risks for all PVT. Further study is needed to better define risks of LT with PVT.

Cited by 131 publications

References 18 publications

Living Donor Liver Transplantation for Patients with Pre-existent Portal Vein Thrombosis

Living Donor Liver Transplantation for Patients with Pre-existent Portal Vein Thrombosis

Use of Left Gastric Vein as an Alternative for Portal Flow Reconstruction in Liver Transplantation

Portal vein thrombosis in patients with cirrhosis

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