Meta‐analysis and systematic review: Prevalence, graft failure, mortality, and post‐operative thrombosis in liver transplant recipients with pre‐operative portal vein thrombosis

Abstract

Aims: This study seeks to evaluate the association between pre-transplant portal vein thrombosis (PVT) and overall survival, graft failure, waitlist mortality, and postoperative PVT after liver transplantation. Methods:A conventional pairwise meta-analysis between patients with and without pre-transplant PVT was conducted using hazard ratios or odds ratios where appropriate.

Liver Transplantation in Patients with Portal Vein Thrombosis: Revisiting Outcomes According to Surgical Techniques

“…Since the publication of that benchmark paper, transplantation surgeons have always relied on the simplicity of this grading system to stratify the patients with PVT at greater risk of ominous outcome after LT. Other PVT classifications have been released aiming fora more precise description of the thrombotic extension in the splanchnic district, the assessment of porto-systemic shunts, and generally with the intention to predict the feasibility of a straightforward porto-portal anastomosis over a more complex surgical reconstruction of the portal flow [ 3 , 4 ]. Authors are now questioning whether the Yerdel grading, and the other classifications, still intercept the different shades of complexity of these patients and reliably predict their outcomes [ 12 ]. Although many recent meta-analyses acknowledge the prominent role of the surgical strategy adopted for portal flow restoration in driving the post-transplantation outcome, the Yerdel classification still represents the starting point for the newly proposed algorithms [ 8 ].…”

Anti-Inflammatory and Anti-Thrombogenic Properties of Arterial Elastic Laminae

“…Autogenous vein- and arterial graft-based arterial reconstruction is an effective approach for the treatment of occlusive arterial disorders. Autogenous venous and arterial grafts have been considered the most reliable graft types because of their natural properties and performance, although these grafts are prone to thrombosis, inflammation, and intimal hyperplasia, resulting in graft stenosis and failure [ 98 , 99 , 100 , 101 , 102 , 103 ]. However, due to limited quantity, vascular disease, or prior harvests, suitable autogenous grafting materials are often unavailable.…”

Portal vein thrombosis: Before, during, and after liver transplant

“…[7] A study by Zanetto and colleagues discovered that the rate of 1-year mortality was greater for patients with prior PVT at 13.5% as compared with 9.9% for patients without PVT after liver transplant. [7,9] Yeo et al [2] discovered that preoperative PVT grade 3 and 4 was associated with an increase in graft loss (HR: 1.58) and patient mortality (HR: 1.45), thought to be due to the requirement of extra-anatomic reconstruction in these patients during surgery. In addition, nonanatomical anastomoses, such as autologous veins, artificial grafts, cadaveric veins or arteries, or polytetrafluoroethylene increase the risk of post-transplant PVT due to the potential of graft kink formation, or anastomoses mismatch leading to portal venous stasis.…”

“…Post-LT complications arise more commonly in patients with cirrhosis with complete PVT as compared with partial PVT, especially if there is involvement of the superior mesenteric vein, which is an especially important surgical consideration as this can result in a lack of end-to-end portal vein (PV) anastomosis, subsequently increasing the risk of graft failure. Other key complications to monitor after liver transplant include biliary strictures, gastrointestinal bleeding, or infections 2 Figure 1. summarizes the risk factors for PVT development, which are branch points of Virchow’s triad.…”