Portal vein thrombosis and liver transplantation: Implications for waiting list period, surgical approach, early and late follow-up

Ponziani, Francesca Romana; Zocco, M.A.; Senzolo, Marco; Pompili, Maurizio; Gasbarrini, Antonio; Avolio, Alfonso Wolfango

doi:10.1016/j.trre.2014.01.003

Cited by 70 publications

(86 citation statements)

References 92 publications

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“…The prevalence of SPSSs (18%) and PVT (10%) in our series is similar to most previously published series of end‐stage liver disease patients undergoing LT: 20%‐40% for SPSSs and 5%‐17% for PVT . Notably, the prevalence of the combination of SPSS and PVT (4.4% [19 patients], respectively, in the present series, Fig.…”

Section: Discussionsupporting

confidence: 90%

Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients

et al. 2018

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The management of large spontaneous portosystemic shunt (SPSS) during liver transplantation (LT) is a matter of debate. The aim of this study is to compare the short-term and longterm outcomes of SPSS ligation versus nonligation during LT, when both options are available. From 2011 to 2017, 66 patients with SPSS underwent LT: 56 without and 10 with portal vein thrombosis (PVT), all of whom underwent successful thrombectomy and could have portoportal reconstruction. The SPSS were either splenorenal (n = 40; 60.6%), left gastric (n = 16; 24.2%), or mesenterico-iliac (n = 10; 15.1%). Following portoportal anastomosis, the SPSS was ligated in 36 (54.4%) patients and left in place in 30 (45.5%) patients, based on the effect of the SPSS clamping/unclamping test on portal vein flow during the anhepatic phase. Intraoperatively, satisfactory portal flow was obtained in both groups. Primary nonfunction (PNF) and primary dysfunction (PDF) rates did not differ significantly between the 2 groups. Nonligation of SPSS was significantly associated with a higher rate of postoperative encephalopathy (P < 0.001) and major postoperative morbidity (P = 0.02). PVT occurred in 0 and 3 patients in the ligated and nonligated shunt group, respectively (P = 0.08). A composite end point, which included the relevant complications in the setting of SPSS in LT (ie, PNF and PDF, PVT, and encephalopathy) was present in 16 (44.4%) and 22 (73.3%) patients of the ligated and nonligated shunt group, respectively (P = 0.02). Patient (P = 0.05) and graft (P = 0.02) survival rates were better in the ligated shunt group. In conclusion, the present study supports routine ligation of large SPSS during LT whenever feasible. Liver Transplantation 24 505-515 2018 AASLD.

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Section: Discussionsupporting

confidence: 90%

Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients

et al. 2018

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“…However, the field of coagulation disorders and chronic liver disease is ever evolving and continues to generate controversy, in particular, when consideration is given to the impact of PVT on the development of hepatic decompensation. Multiple studies have been published indicating adverse clinical outcomes in the setting of PVT in both transplant and non-transplant populations, including hepatic decompensation, increased posttransplant mortality, and decreased quality of life [7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

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

Stine

Shah

Cornella

et al. 2015

WJH

113

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AIM:To determine the clinical impact of portal vein thrombosis in terms of both mortality and hepatic decompensations (variceal hemorrhage, ascites, portosystemic encephalopathy) in adult patients with cirrhosis. METHODS:We identified original articles reported through February 2015 in MEDLINE, Scopus, Science Citation Index, AMED, the Cochrane Library, and relevant examples available in the grey literature. Two independent reviewers screened all citations for inclusion criteria and extracted summary data. Random effects odds ratios were calculated to obtain aggregate estimates of effect size across included studies, with 95%CI. RESULTS:A total of 226 citations were identified and reviewed, and 3 studies with 2436 participants were included in the meta-analysis of summary effect. Patients with portal vein thrombosis had an increased risk of mortality (OR = 1.62, 95%CI: 1.11-2.36, P = 0.01). Portal vein thrombosis was associated with an increased risk of ascites (OR = 2.52, 95%CI: 1.63-3.89, P < 0.001). There was insufficient data available to determine the pooled effect on other markers of META-ANALYSISSubmit a

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“…Alone, PVT is an increasingly recognized complication of cirrhosis and is often incidentally detected either with advances in noninvasive liver imaging, in the setting of hepatic decompensation, or even during the LT procedure . The prevalence of PVT in patients with cirrhosis presenting for LT has had an increasing trajectory ranging from 2% to 26% . However, in the setting of an inherent proinflammatory/prothrombotic state, NASH patients with cirrhosis have an increased predilection for PVT …”

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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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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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Portal vein thrombosis and liver transplantation: Implications for waiting list period, surgical approach, early and late follow-up

Cited by 70 publications

References 92 publications

Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients

Ligation versus no ligation of spontaneous portosystemic shunts during liver transplantation: Audit of a prospective series of 66 consecutive patients

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

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

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