Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome

Lendoire, Javier; Raffin, G.; Cejas, N; Duek, Fernando; Schelotto, Pablo Barros; Trigo, Pedro; Quarin, Carlos; Garay, Verónica; Imventarza, Oscar

doi:10.1080/13651820701599033

Cited by 100 publications

(90 citation statements)

References 20 publications

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“…Survival after transplantation is reduced in patients with PVT as compared to those without. [18][19][20] Recently, in a cross-sectional study, we showed that the ETP, a parameter of the thrombin- *Percent activity relative to the reference normal plasma set at 100%. N, numbers of observations.…”

Section: Discussionmentioning

confidence: 99%

Detection of the imbalance of procoagulant versus anticoagulant factors in cirrhosis by a simple laboratory method

et al. 2010

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Patients with cirrhosis possess an imbalance in procoagulant versus anticoagulant activity due to increased factor VIII and decreased protein C. This imbalance can be detected by thrombin-generation assays performed in the presence/absence of thrombomodulin (predicate assay) that are not readily available in clinical laboratories. We sought to assess this hypercoagulability with a simpler thrombin-generation assay performed in the presence/ absence of Protac, a snake venom that activates protein C in a manner similar to thrombomodulin (new assay). We analyzed blood from 105 patients with cirrhosis and 105 healthy subjects (controls). Results for the predicate-assay or the new-assay were expressed as ratio (with:without thrombomodulin) or as Protac-induced coagulation inhibition (PICI%). By definition, high ratios or low PICI% translate into hypercoagulability. The median(range) PICI% was lower in patients (74% [31%-97%]) than controls (93% [72%-99%]; P < 0.001), indicating that patients with cirrhosis are resistant to the action of Protac. This resistance resulted in greater plasma hypercoagulability in patients who were Child class C than those who were A or B. The hypercoagulability of Child C cirrhosis (63% [31%-92%]) was similar to that observed for patients with factor V Leiden (69% [15%-80%]; P 5 0.59). The PICI% values were correlated with the levels of protein C (rho 5 0.728, P < 0.001) or factor VIII (rho 5 20.517, P < 0.001). Finally, the PICI% values were correlated with the predicate assay (rho 5 20.580, P < 0.001). Conclusion: The hypercoagulability of plasma from patients with cirrhosis can be detected with the new assay, which compares favorably with the other markers of hypercoagulability (i.e., high factor VIII and low protein C) and with the predicate-assay based on thrombin-generation with/without thrombomodulin. Advantages of the new assay over the predicate assay are easy performance and standardized results. Prospective trials are needed to ascertain whether it is useful to predict thrombosis in patients with cirrhosis. (HEPATOLOGY 2010;52:249-255)

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Section: Discussionmentioning

confidence: 99%

Detection of the imbalance of procoagulant versus anticoagulant factors in cirrhosis by a simple laboratory method

et al. 2010

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“…172 Portal vein thrombosis is associated with greater operative complexity and rethrombosis but has no influence on overall morbidity and mortality. 173 Liver transplantation in PVT however has been associated with an increased operative time, transfusion requirements, reintervention and lower survival rate depending on PVT extension. 174 Surgical techniques like thrombectomy, thromboendovenectomy with venous reconstitution, interposition of vein graft, portocaval liver transposition have all been done including radiological endovascular interventions to overcome venous obstruction in the recipient.…”

Section: Liver Transplant (Lt) In Portal Vein Thrombosismentioning

confidence: 99%

Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

143

147

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Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. ( J CLIN EXP HEPATOL 2015;5:22-40)

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“…PVT is frequent in cirrhosis [35,48,[179][180][181][182][183][184][185][186][187][188][189][190], with a 1-year incidence of 4.6-16.7% (Table 4), and prevalence of 1.4-26.1% (Table 5). Prevalence increases with the severity of cirrhosis [186,190], with rates of up to 44.4% in patients with hepatocellular carcinoma.…”

Section: Portal Vein Thrombosis In Cirrhosismentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome

Cited by 100 publications

References 20 publications

Detection of the imbalance of procoagulant versus anticoagulant factors in cirrhosis by a simple laboratory method

Detection of the imbalance of procoagulant versus anticoagulant factors in cirrhosis by a simple laboratory method

Portal Vein Thrombosis

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

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