Tailored classification of portal vein thrombosis for liver transplantation: Focus on strategies for portal vein inflow reconstruction

Teng, Fei; Sun, Ke-Yan; Fu, Zhi-ren

doi:10.3748/wjg.v26.i21.2691

Cited by 17 publications

(16 citation statements)

References 59 publications

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“…While some studies associate PVT development with further increases in portal hypertension, hepatic decompensation, or even an increased risk of mortality [9], other studies claim that there is no correlation between the development of PVT and the progression of the disease [10,11]. However, data are clearer in the setting of a liver transplantation, where PVT can have a detrimental impact, especially if it is occlusive and it impairs physiological anastomosis [12,13]. The presence of PVT may even be a contraindication for liver transplantation, due to the increased surgical complexity and its association with worse outcomes and increased mortality after the transplant [14,15].…”

Section: Introductionmentioning

confidence: 99%

The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad

Anton

Campreciós

Pérez-Campuzano

et al. 2022

JCM

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Portal vein thrombosis (PVT) is a common complication among patients with cirrhosis. However, its pathophysiology is not well established and there are currently very few predictive factors, none of which are actually useful, from a clinical perspective. The contribution of each of the vertices of Virchow’s triad, e.g., blood hypercoagulability, blood flow, and portal vein endothelial damage in the development of PVT is not clear. In this review, we aim to recapitulate the latest studies on the field of PVT development in order to understand its mechanisms and discuss some of the future directions in the study of this important complication of cirrhosis.

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Section: Introductionmentioning

confidence: 99%

The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad

Anton

Campreciós

Pérez-Campuzano

et al. 2022

JCM

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“…The last algorithms were presented by Bhangui et al in 2019 15 and by Teng et al in 2020. 16 They were intended for further evolution of the previous grading systems, aiming to guide surgical decision-making.…”

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confidence: 99%

Liver transplantation in patients with non‐neoplastic portal vein thrombosis: 20 years of experience in a single center

Pinelli

Camagni

Amaduzzi

et al. 2021

Clinical Transplantation

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Background:The Yerdel classification is widely used for describing the severity of portal vein thrombosis (PVT) in liver transplant (LT) candidates, but might not accurately predict transplant outcome. Methods:We retrospectively analyzed data regarding 97 adult patients with PVT who underwent LT, investigating whether the complexity of portal reconstruction could better correlate with transplant outcome than the site and extent of the thrombosis.Results: 79/97 (80%) patients underwent thrombectomy and anatomical anastomosis (TAA), 18/97 (20%) patients underwent non-anatomical physiological reconstructions (non-TAA). PVT Yerdel grade was 1-2 in 72/97 (74%) patients, and 3-4 in 25/97 (26%) patients. Univariate analysis revealed higher 30-day mortality, 90-day mortality, 1-year mortality, and a higher rate of severe early complications in the non-TAA group than in the TAA group (p = .018, .001, .014, .009, respectively). In the model adjusted for PVT Yerdel grade, non-TAA remained independently associated with higher 30-day, 90-day, and 1-year mortality (p = .021, .007, and .015, respectively). The portal vein rethrombosis and overall patient and graft survival rates were similar.Discussion: In our experience, the complexity of portal reconstruction better correlated with transplant outcome than the Yerdel classification, which did not even appear to be a reliable predictor of the surgical complexity and technique.

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“…(Continued in Supplementary Material, SDC , http://links.lww.com/TP/C321 ). (4.1) In the absence of coagulopathy, liver graft dysfunction or low platelet count (<30 000–50 000/µL), patients with risk factors of portal vein thrombosis (Table 2 from the main document) should receive therapeutic low molecular weight heparin (ie, 1 mg/kg) started within the first 24 h after surgery 88 , 89 (Recommendation 1B). …”

Section: Methodsmentioning

confidence: 99%

Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation

et al. 2022

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Tailored classification of portal vein thrombosis for liver transplantation: Focus on strategies for portal vein inflow reconstruction

Cited by 17 publications

References 59 publications

The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad

The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad

Liver transplantation in patients with non‐neoplastic portal vein thrombosis: 20 years of experience in a single center

Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation

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