The Incidence of Portal Vein Thrombosis At Liver Transplantation

Abstract

The incidence of portal vein thrombosis was examined in 885 patients who received orthotopic liver transplantations for various end‐stage liver diseases between 1989 and 1990. The thrombosis was classified into four grades. Grade 1 was thrombosis of intrahepatic portal vein branches, grade 2 was thrombosis of the right or left portal branch or at the bifurcation, grade 3 was partial obstruction of the portal vein trunk, and grade 4 was complete obstruction of the portal vein trunk. Among the 849 patients without previous portosystemic shunt, 14 patients (1.6%) had grade 1, 27 patients (3.2%) had grade 2, 27 patients (3.2%) had grade 3 and 49 patients (5.8%) had grade 4 portal vein thrombosis. The incidence of portal vein thrombosis was highest (34.8%) in the patients with hepatic malignancy in the cirrhotic liver, followed by those with Budd‐Chiari syndrome (22.2%) and postnecrotic cirrhosis of various causes (15.7%). The patients with encephalopathy, ascites, variceal bleeding, previous splenectomy and small liver had significantly higher incidences of portal vein thrombosis than the others. The total incidence of portal vein thrombosis among the 36 patients with previous portosystemic shunt was 38.9%, which was significantly higher than that (13.8%) of those without shunt. (HEPATOLOGY 1992;16;1195–1198.)

Portal vein thrombosis in liver cirrhosis

“…The reported prevalence of PVT is in the range of 0.6%-15.8% in patients with liver cirrhosis or portal hypertension [9][10][11][12][13][14][15] . The presence of PVT is reportedly 0.6% when evaluated by angiographic studies [9] , 4.4% when evaluated by ultrasound [10] , and 10%-12% when evaluated by computed tomography and magnetic resonance imaging [1,11] .…”

“…The presence of PVT is reportedly 0.6% when evaluated by angiographic studies [9] , 4.4% when evaluated by ultrasound [10] , and 10%-12% when evaluated by computed tomography and magnetic resonance imaging [1,11] . Moreover, the prevalence of PVT increases with patient age and liver disease severity, reaching 15% in patients awaiting liver transplantation [12][13][14][15] . The etiology of liver disease influenced the prevalence of PVT in a study of 885 patients who underwent liver transplantation.…”

“…The etiology of liver disease influenced the prevalence of PVT in a study of 885 patients who underwent liver transplantation. The prevalence of PVT was 3.6% in primary sclerosing cholangitis, 8% in primary biliary cirrhosis, 16% in alcoholic and hepatitis B virus-related cirrhosis, and 35% in hepatocellular carcinoma (HCC) [12] .…”

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

“…Portal vein thrombosis (PVT) is frequently observed in the candidates awaiting LT and potentially i n c r e a s e s t h e t e c h n i c a l complexity [4][5][6][7][8]. With the substantial improvement of surgical techniques [9][10], the presence of PVT has been no longer considered as an absolute contraindication for LT [11].…”

Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?

“…In the largest study to date a prevalence of 11% was reported in 701 patients with cirrhosis [5]. Once considered an absolute contraindication to orthotopic liver transplantation (OLT), portal vein thrombosis (PVT) can be managed operatively with thrombectomy or venous replacement conduits; however due to the surgical complexity and high risk for recurrence, it remains a formidable clinical problem [2,[6][7][8][9][10]. While mostly associated with hepatocellular carcinoma, PVT in cirrhotic patients, even in the absence of neoplasia may be the result of an underlying hypercoagulable disorder, as is suggested by some preliminary data [11][12][13].…”