Prevalence and outcome of portal thrombosis in a cohort of cirrhotic patients undergoing liver transplantation

Abstract

Introduction:The prevalence of portal vein thrombosis (PVT) in patients that have undergone liver transplantation (LT) is 9.7% (SD 4.5). The aim of our study was to determine the prevalence, assess the factors that are associated with PVT and clarify their association with prognosis in patients with liver cirrhosis (LC) and LT.Aims and methods: From 2005 to 2014, laboratory, radiological and surgical data were collected from patients with LC in our center who had undergone LT for the first time.Results: One hundred and ninety-one patients were included. The mean age was 55 (SD 9), 75.4% of patients were male and 48.7% had HCV. The Child-Pugh scores were A/B/C 41.9%/35.9%/25.5% and the MELD score was 15 (SD 6). Previous decompensations were: ascites (61.4%), hepatic encephalopathy (34.4%), variceal bleeding (25.4%), hepatocellular carcinoma (48.9%) and spontaneous bacterial peritonitis (SPB) (14.3%). The mean post-transplant follow-up was 42 months (0-113). PVT was diagnosed at LT in 18 patients (9.4%). Six patients were previously diagnosed using imaging tests (33.3%): 2 patients (11.1%) by DU and 4 patients (22.2%) by CT scan. All patients with PVT had DU in a mean time of 6 months before LT (0-44) and 90 patients (47.1%) had a CT scan in a median time of 6 months before LT (0-45). PVT was significantly related to the presence of SBP (33.3% vs 12.6%; p = 0.02) and lower levels of albumin (3.1g/dl vs 3.4g/ dl; p = 0.05). MELD was higher in patients with PVT (16.6 vs 14.9; p = 0.3). There were no significant differences with regard to the need for transfusion of blood components. Moreover, the surgery time was similar in both groups. PVT correlated with a higher mortality in the first 30 days (8.8% vs 16.7%; p = 0.2).Conclusion: Prior history of SBP and lower levels of albumin were identified as factors associated with PVT. The pre-transplant diagnosis rate is very low and the presence of PVT may have implications for short-term mortality.

Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture

“…Cruz et al[ 22 ] demonstrated that non-alcoholic steato-hepatitis was more frequently associated with PVT (40.48%), followed by hepatitis C virus (23.81%) and autoimmune hepatitis (19.05%), all of these etiologies being characterized by a significant pro-inflammatory status. By contrast, in another study with 199 candidates for LT, no relation was found between the etiology of liver disease and PVT prevalence[ 23 ].…”

Portal vein thrombosis in cirrhosis: diagnosis, natural history, and therapeutic challenges

“…In most cases the operative time is extended, more transfusions are required and there is a greater possibility of reoperation, whereas PVT extension plays a decisive role in the survival rate [ 81 , 82 ]. Generally, overall morbidity and mortality in LT recipients of are not influenced by the presence of PVT [ 83 ]. However, in a recent meta-analysis [ 84 ], it was demonstrated that LT recipients with pre-LT PVT had a significantly lower 1-year survival rate compared to those without (odds ratio [OR] 0.733, 95% confidence interval [CI] 0.621-0.865).…”

Risk factors and impact of portal vein thrombosis in liver transplantation

“…PVT had been previously described as a factor that increases mortality within 30 days post-transplant (2,30). The study by Ghabril et al (14) that used the OPTN database found that PVT represents an independent mortality risk factor in the first 90 days post-transplant and in graft failure.…”

“…Not all the mechanisms involved in the pathophysiology of PVT in cirrhotic patients are well understood. However, selected predictive factors have been described, including reduced portal flow (2), the presence of collateral circulation (4), prior damage to the portal vein system (5) and focal inflammatory injuries (6). Cirrhosis-associated rebalanced hemostasis, where procoagulant factors may predominate, adds to this condition (7)(8)(9).…”

“…Laboratory test results are nonspecific. However, some studies report moderate reductions in prothrombin and other coagulation factor levels, as well as increased D-dimer levels (2,(11)(12)(13).…”