Outcomes of Liver Transplantation in Candidates With Portal Vein Thrombosis

Artacho, G. Suárez; Barrera-Pulido, L.; Martínez, J. M. Álamo; Díez-Canedo, J. Serrano; Bellido, C. Bernal; Gómez, Luis Miguel Marín; Padillo-Ruíz, Javier; Bravo, Miguel Ángel Gómez

doi:10.1016/j.transproceed.2010.05.057

Cited by 38 publications

(30 citation statements)

References 8 publications

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“…Our results echo previous studies showing decreased survival in patients with PVT . However, our results lead to the new finding that NASH transplant recipients with PVT have compromised graft and patient survival compared with NASH transplant recipients without PVT, independent of recipient demographic and comorbidities as well as donor‐related factors.…”

Section: Discussionsupporting

confidence: 88%

“…Multiple studies report conflicting results in terms of the presence of PVT and posttransplant outcomes. However, many of these studies are plagued with heterogeneous study populations, with much of the literature including recipients transplanted for primary liver tumors in their population . We excluded these patients in our population to avoid any potential bias of HCC or cholangiocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Nonmalignant Portal Vein Thrombosis in Transplant Recipients With Nonalcoholic Steatohepatitis

Agbim

Jiang²,

Kedia³

et al. 2019

Liver Transpl

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Nonalcoholic fatty liver disease (NAFLD) is an increasingly prevalent condition and its more severe progressive state, nonalcoholic steatohepatitis (NASH), is currently the second most common indication for waitlisted adults in the United States. The association of portal vein thrombosis (PVT) prior to or at transplant and poor graft and patient outcomes is not well established, particularly among NASH patients who inherently have an increased hypercoagulable profile. Using the United Network for Organ Sharing dataset, we analyzed graft and patient outcomes of patients transplanted for the indication of NASH with and without PVT. Of 3,689 NASH transplant recipients, the prevalence of PVT was 12% (450 with PVT and 3,239 without PVT). NASH transplant recipients with PVT had inferior graft and patient survival compared to NASH transplant recipients without PVT, even after adjusting for recipient and donor demographic characteristics, body mass index (BMI), synthetic dysfunction, and presence of diabetes. In a multivariate Cox regression model, NASH transplant recipients with PVT had a 37% increased risk of graft failure (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.15-1.63; P < 0.001) and 31% increased risk of overall death (HR, 1.31; 95% CI, 1.09-1.58; P < 0.001) compared with NASH transplant recipients without PVT at transplant. This difference in graft and patient survival was most pronounced in the early post-transplant period. These results demonstrate NASH patients with PVT have decreased graft and patient survival independent of recipient and donor factors. This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Impact of Nonmalignant Portal Vein Thrombosis in Transplant Recipients With Nonalcoholic Steatohepatitis

Agbim

Jiang²,

Kedia³

et al. 2019

Liver Transpl

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“…Four papers compared the 1-year survival between the LT recipients with complete PVT and those without PVT [34,36,38,39]. The test for heterogeneity was not statistically significant (I²=21.1%, P=0.283).…”

Section: Survival Of Lt Recipients With Partial and With Complete Pvtmentioning

confidence: 99%

“…Three papers compared the 1-year survival between the LT recipients with partial PVT and those without PVT [36,38,39]. All of them demonstrated that this was mildly higher in patients with partial PVT than in those without PVT (in the paper by Suarez Artacho: 82.1% versus 70.9% [36]; in the paper by Kim: 89.5% versus 89.1% [38]; in the paper by Ravaioli: 88% versus 86% [39]). But none of them showed a statistically significant association.…”

Section: Survival Of Lt Recipients With Partial and With Complete Pvtmentioning

confidence: 99%

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Dai

Jia

et al. 2015

JGLD

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Background & Aims: Portal vein thrombosis (PVT) increases the technical complexity of liver transplantation (LT). This systematic review and meta-analysis aim to analyze the association of pre-LT PVT with the overall survival after LT.Methods. PubMed, EMBASE, and Cochrane library databases were used to search for papers related to the association between pre-LT PVT and survival of LT recipients. The differences in the survival rates between the LT recipients with and without pre-LT PVT were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).Results. Twenty-seven papers were included. Overall meta-analysis showed that the total LT recipients with pre-LT PVT had a significantly lower 1-year survival rate than those without pre-LT PVT (OR=0.733, 95%CI=0.621-0.865; P=0.0002). But no statistically significant difference was observed in the in-hospital (OR=0.713, 95%CI=0.343-1.482; P=0.365), 1-month (OR=0.679, 95%CI=0.345-1.333; P=0.261), or 5-year survival rate (OR=0.788, 95%CI=0.587-1.058; P=0.113). Additionally, the 1-year survival rate was significantly lower in the LT recipients with complete PVT than in those without PVT (OR=0.503, 95%CI=0.295-0.858; P=0.012). However, no statistically significant difference in the 1-year survival rate between them was observed in the meta-analysis of high-quality studies (OR=0.899, 95%CI=0.657-1.230; P=0.505) or that of studies in which LT was performed after 2000 (OR=0.783, 95%CI=0.566-1.083; P=0.140).Conclusion. Pre-LT PVT, especially complete PVT, decreased the 1-year survival rate after LT. However, the detrimental effect of pre-LT PVT on the survival of LT recipients became inconclusive in high-quality studies. Additionally, further well-designed cohort studies should validate the association in patients undergoing LT during the latter years.

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“…Whether PVT is an independent risk factor or is a surrogate marker of severity in cirrhosis is still debated [3]. Several studies have shown that PVT could increase post-transplant mortality and morbidity [3,10,46]. By contrast, for a given MELD score, evidence that patients with PVT are at higher risk of waiting list mortality compared to patients without thrombosis is lacking.…”

Section: Endovascular Procedures and Fibrinolysismentioning

confidence: 99%