Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Abstract

Portal vein thrombosis (PVT) occurs in approximately 2%-26% of the patients awaiting liver transplantation (LT) and is no longer an absolute contraindication for LT. Nearly half of PVT cases are accidentally found during the LT procedure. The most important risk factor for PVT development in cirrhosis may be the severity of liver disease and reduced portal blood flow. Whether other inherited or acquired coagulation disorders also play a role is not yet clear. The development of PVT may have no effect on the liver disease progression, especially when it is nonocclusive. PVT may not increase the risk of wait-list mortality, but it is a risk factor for poor early post-LT mortality. Anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) are 2 major treatment strategies for patients with PVT on the waiting list. The complete recanalization rate after anticoagulation is approximately 40%. The role of TIPS to maintain PV patency for LT as the primary indication has been reported, but the safety and efficacy should be further evaluated. PVT extension and degree may determine the surgical technique to be used during LT. If a "conventional" end-to-end portal anastomotic technique is used, there is not a major impact on post-LT survival. Post-LT PVT can significantly reduce both graft and patient survival after LT and can preclude future options for re-LT. Liver Transpl 22:352-365, 2016. V C 2015 AASLD.

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

“…Although PVT rarely occurs in the general population, it is relatively common in patients with liver cirrhosis . Based on the severity of liver cirrhosis, PVT prevalence has been estimated to be 5%‐26% with increasing incidence and prevalence in parallel to severity of the liver disease . While PVT remains uncommon in compensated cirrhosis, its prevalence increases in patients with decompensated cirrhosis who are in liver transplant waiting list .…”

Portal Vein Thrombosis and Nephrotic Syndrome After Liver Transplant

“…Posttransplant PVT can therefore significantly reduce both graft and patient survival after liver transplant and can cause limitations or loss of future options for retransplant. 12 For our patient, this situation was not applicable, as our patient did not present PVT at the time of liver transplant. In addition, a PVT as a complication of postoperative anastomotic stricture was ruled out by morphologic evaluation and late outcome.…”

Giant Splenorenal Shunt in a Young Patient with Autoimmune Hepatitis/Primary Biliary Cholangitis Overlap Syndrome and Portal Vein Thrombosis

“…The main limitation is delimiting the extension of the thrombi to SV or SMV [7]. When technical conditions are adverse contrast enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are both good options to delineate the extent and the precise location of the thrombus.…”