Increased risk of portal vein thrombosis in patients with cirrhosis due to nonalcoholic steatohepatitis

Abstract

Portal vein thrombosis (PVT) is a common complication of cirrhosis sometimes implicated in hepatic decompensation. There are no consistent epidemiologic data to suggest an increased risk of thrombotic complications in nonalcoholic steatohepatitis (NASH); however, research suggests an increased risk of thrombosis. Our aim was to examine the independent association between NASH cirrhosis and PVT in patients who underwent liver transplantation (LT) in a cross-sectional study. Data on all LTs occurring in the United States between January 1, 2003 and December 31, 2012 were obtained from the United Network for Organ Sharing. Multivariable models were constructed to assess the statistical associations and risk factors for the development of PVT. A total of 33,368 patients underwent transplantation. Of these, 2096 (6.3%) had PVT. Of the patients with PVT, 12.0% had NASH. When we compared these patients to a composite of all other causes of cirrhosis, an increased prevalence of PVT was again found, with 10.1% having PVT at the time of transplantation versus 6.0% without NASH (P < 0.001). The strongest risk factor independently associated with a diagnosis of PVT in a multivariable analysis was NASH cirrhosis (odds ratio, 1.55; 95% confidence interval, 1.33-1.81; P < 0.001). NASH cirrhosis appears to predispose a patient to PVT independently of other risk factors. These epidemiological findings provide support for the idea that NASH is a prothrombotic state, and they should lead to more research in treatment and prevention in this population. Liver

Portal vein thrombosis in patients with liver cirrhosis and its impact on early and long‐term outcomes after liver transplantation

“…The other interesting finding of our study was the identification of cryptogenic‐NASH cirrhosis as a risk factor for PVT, independent of other risk factors including DM. This is in concordance with two other previous studies showing NASH as a risk factor for PVT in patients with cirrhosis . The precise underlying mechanism, however, is not evident.…”

Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis: A meta-analysis

“…This finding is important because PVT is a common finding in patients with cirrhosis [4,6,19] and one that significantly impairs quality of life and post-LT outcomes [7][8][9] . Several risk factors have been suggested to increase the risk of PVT in patients awaiting liver transplantation, including non-alcoholic steatohepatitis [20] . The risk of hepatic decompensation with ascites for patients with cirrhosis was also significantly greater in the presence of PVT.…”

The Role of Nuclear Receptors in the Pathophysiology, Natural Course, and Drug Treatment of NAFLD in Humans

“…As regards the relationship of the etiology of cirrhosis with the risk of PVT, a nationwide US survey enrolling, overall, 33,368 patients who underwent liver transplantation reported that NASH cirrhosis was the strongest risk factor independently associated with PVT [229]. These data attest that NASH is a prothrombotic state and suggest that PVT prevention may be particularly indicated in this population.…”