The Recipient With Portal Thrombosis and/or Previous Surgery

Arcadipane, Antonio; Nadalin, Silvio; Gruttadauria, Salvatore; Panarello, Giovanna; Burgio, Gaetano; Vizzini, Giovanni; Luca, Angelo; Gridelli, Bruno

doi:10.1016/j.transproceed.2008.03.073

Cited by 17 publications

(11 citation statements)

References 12 publications

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“…In our series, the total frequency of PVT was 4.7% (7 of 145 patients), which was similar to the findings of previous studies showing portal vein thromboses ranging from 2 to 16% (depending on patient selection and the diagnostic methods used) [11,12,14]. The frequency of signs of portal hypertension in this study was similar to that of other reports [28].…”

Section: Discussionsupporting

confidence: 91%

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Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation

et al. 2009

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The purpose of this study was to evaluate the accuracy of MDCT for preoperative assessment of hepatic vascular anatomy and the identification of liver-transplantation (OLT) patients at risk of developing subsequent splenic artery steal syndrome (SASS). A total of 145 patients with liver cirrhosis who had undergone OLT and had pre-operative three-phase MDCT (4- to 64-rows) within 100 days before OLT were enrolled retrospectively. MDCT and 3Ds were reviewed by two independent blinded observers (O1/O2). Pre-operative imaging findings were correlated with intra-operative results; findings indicative for SASS were correlated with clinical data and DSA. Among all 145 patients, 16 patients (11%) showed accessory hepatic arteries (accuracy O1/O2, 97%; with 3Ds, 100%); 32 (22%) patients had replaced hepatic arteries (accuracy O1, 97%; O2, 95%; with 3Ds, 100%; kappa = 0.87 and 0.89, P < 0.001). Among 119 patients, 12 patients developed SASS after OLT. The logistic regression model revealed the spleen volume (P = 0.0105) as a predictive factor of SASS. With spleen volumes >or=829 ml, an accuracy of 75% for prediction of SASS was obtained. MDCT with three-dimensional post-processing (3Ds) was highly accurate for pre-operative hepatic vessel evaluation in patients before OLT. In addition, spleen volume was a predictive factor for developing SASS after OLT.

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Section: Discussionsupporting

confidence: 91%

“…Haemodynamic changes with portal hypertension are of importance for surgical planning. The presence of portal vein thrombosis (PVT) is considered a risk factor with increased recipient morbidity and mortality [11,12]. Surgical decisionmaking strongly depends on the extent of thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation

et al. 2009

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“…Amongst 98 558 LTs described in the studies considered, 7257 were performed in patients with PVT. The prevalence ranged from 2.1% in studies describing LT procedures performed before 1990 to 23.3% in more recent series (Table ) . The low prevalence reported by some authors may be attributable to different policies adopted at the various transplant centers resulting in patients with extensive thrombosis of the splanchnic vessels being excluded from the waiting list for LT.…”

Section: Resultsmentioning

confidence: 99%

Mortality in liver transplant recipients with portal vein thrombosis - an updated meta-analysis

et al. 2018

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Portal vein thrombosis (PVT) is the most common thrombotic event in liver transplant (LT) recipients, but its impact on mortality after LT has been analyzed in heterogeneous cohorts with mixed results. To conduct a meta-analysis on the impact of PVT on post-LT survival. A systematic search was conducted on studies (published from January 1986 to January 2018) that reported 30-day and 1-year mortality after LT of PVT patients. Four hundred twenty-seven articles were reviewed and 44 were included. Among 98 558 LT, 7257 (7.3%) involved patients with PVT. The mean quality was high (7.1 on the Newcastle-Ottawa scale). The 30-day pooled mortality rate was higher for patients with PVT (64/490; 13%) than for others (259/3357; 7%) (OR 2.29; 95% CI 1.43-3.68; P < 0.0001). One-year mortality was likewise higher in recipients with (853/6302; 13.5%) than in those without PVT (7476/75 355; 9.9%) (OR 1.38; 95% CI 1.14-1.66; P < 0.0001). Heterogeneity wasn't significant (I 46% and 65%). Patients whose PVT was complete had a higher 30-day pooled mortality rate (OR 5.65; 95% CI 2-15.96; P < 0.0001), and a 1-year mortality rate (OR 2.48; 95% CI 0.99-6.17; P = 0.38) than patients with partial PVT. PVT is common in LT candidates and it is associated with higher short- and medium-term mortality after LT.

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“…The medium-term results with or without PVT appear roughly comparable if the early mortality is excluded. 79,87 CONCLUSIONS PVT is a common problem in cirrhosis, mostly in individuals with advanced liver disease. PVT is an important prognostic factor of cirrhosis and also bears significance in individuals undergoing liver transplantation.…”

Section: Outcomes After Liver Transplantationmentioning

confidence: 99%

Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term. ( J CLIN EXP HEPATOL 2013;4:320-331)

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The Recipient With Portal Thrombosis and/or Previous Surgery

Cited by 17 publications

References 12 publications

Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation

Multidetector computed tomography for preoperative assessment of hepatic vasculature and prediction of splenic artery steal syndrome in patients with liver cirrhosis before transplantation

Mortality in liver transplant recipients with portal vein thrombosis - an updated meta-analysis

Portal Vein Thrombosis in Cirrhosis

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