Year 2019 / Volume 111 / Number 6
Original
Risk factors and impact of portal vein thrombosis in liver transplantation

437-444

DOI: 10.17235/reed.2019.5819/2018

Lorena Reyes, José Ignacio Herrero, Fernando Rotellar Sastre, José Antonio Páramo,

Abstract
Introduction: portal vein thrombosis is a relatively common complication of advanced cirrhosis that increases perioperative risk in liver transplant recipients. This condition was characterized in a cohort of patients, including risk factors and their influence on survival. Material and methods: a retrospective study of liver transplant recipients at the Clínica Universidad de Navarra was performed between 2000 and 2015. Differences in clinical and biological characteristics and survival were analyzed in subjects with and without portal vein thrombosis. A predictive index was also developed. Results: a total of 288 patients were included in the study, portal vein thrombosis was recorded in 46 (16%) cases and seven (15.2%) had stage 3/4 disease according to Yerdel’s classification. Factors associated with the presence of esophageal/gastric varices (OR = 3.7; p = 0.03) included variceal ligation or sclerotherapy (OR = 2.3; p = 0.01), being overweight/obesity (OR = 2.1; p = 0.04) and thrombocytopenia (OR = 3.6; p = 0.04). There were no significant differences between the groups with and without portal vein thrombosis in terms of survival according to Kaplan-Meier curve analysis (p = 0.7). However, the mortality rate was higher for Yerdel stages 3-4 (p < 0.01). A predictive index was developed that included varices, body mass index (BMI), thrombocytopenia and activated partial thromboplastin time (APTT). This index had a sensitivity of 76.1% and a specificity of 53.7% for the development of portal thrombosis. Conclusions: the presence of esophageal/gastric varices, variceal ligation/sclerotherapy, thrombocytopenia and being overweight/obesity was associated with a higher rate of portal vein thrombosis. Advanced stages had an impact on survival.
Share Button
New comment
Comments
No comments for this article
References
1. Shaw BW, Iwatsuki S, Bron K, Starzl TE. Portal vein grafts in hepatic transplantation. Surg Gynecol Obstet. 1985;161(1):66–8.
2. Hernández-Conde M, Llop E, De-La Revilla J, Pons F, Fernández-Puga N, Martínez-Porras JL, et al. Prevalence and outcome of portal thrombosis in a cohort of cirrhotic patients undergoing liver transplantation. Rev Esp Enfermedades Dig. 2016;108(11):716–20.
3. Karvellas CJ, Cardoso FS, Wells MM, Handoo FA, Kwapisz L, Alghanem MG, et al. Impact of portal vein thrombosis prior to liver transplantation: A retrospective cohort study. Hepatology. 2017;16(2):236–46.
4. Maruyama H, Okugawa H, Takahashi M, Yokosuka O. De novo Portal Vein Thrombosis in Virus-Related Cirrhosis: Predictive Factors and Long-Term Outcomes. Am J Gastroenterol. 2013;108(4):568–74.
5. Hui C et al. Nontumoral Portal Vein Thrombosis in Patients Awaiting Liver Transplantation. Liver Transplant. 2016;22:352–65.
6. Stine et al. Increased risk of portal vein thrombosis in patients with cirrhosis due to nonalcoholic steatohepatitis. Liver Transplant. 2015;21:1016–21.
7. Lisman T, Violi F. Cirrhosis as a risk factor for venous thrombosis. Thromb Haemost. 2017;7(1):3–5.
8. Tripodi A, Primignani M, Mannucci PM, Caldwell SH. Changing Concepts of Cirrhotic Coagulopathy. Am J Gastroenterol. 2017;112(2):274–81.
9. Tripodi A. Hemostasis in Acute and Chronic Liver Disease. 2017;28–32.
10. Manzano-robleda MC, Barranco-fragoso B, Uribe M, Méndez-sánchez N. Portal vein thrombosis : What is new? Ann Hepatol. 2015;14(1):20–7.
11. Zhang D, Hao J, Yang N. Protein C and D-dimer are related to portal vein thrombosis in patients with liver cirrhosis. J Gastroenterol Hepatol. 2010;25(1):116–21.
12. Fei Y, Zong GQ, Chen J, Liu RM. Evaluation of the Value of d -Dimer, P-Selectin, and Platelet Count for Prediction of Portal Vein Thrombosis after Devascularization. Clin Appl Thromb. 2014;22(5):471–5.
13. Dai J, Qi X, Peng Y, Hou Y, Chen J, Li H, et al. Association between D-dimer level and portal venous system thrombosis in liver cirrhosis: A retrospective observational study. Int J Clin Exp Med. 2015;8(9):15296–301.
14. Ghabril M, Agarwal S, Lacerda M, Chalasani N, Kwo P, Tector AJ. Portal Vein Thrombosis Is a Risk Factor for Poor Early Outcomes After Liver Transplantation. Transplantation. 2016;100(1):126–33.
15. Montenovo M, Rahnemai-azar A, Reyes J, Perkins J. Clinical Impact and Risk Factors of Portal Vein Thrombosis for Patients on Wait List for Liver Transplant. 2017;
16. Peng soon Koh, see Ching Chan, Kenneth siu-ho chok, william Wei Sharr, Tiffany cho-lam wong, Sui Ling Sin CM Lo. The Friendly Incidental Portal Vein Thrombous in Liver Transplantation. Liver Transplant. 2015;21:944–52.
17. Blokhin IO, Lentz SR. Mechanisms of thrombosis in obesity. Vol. 20, Current Opinion in Hematology. 2013. p. 437–44.
18. Bureau C, Laurent J, Robic MA, Christol C, Guillaume M, Ruidavets JB, et al. Central obesity is associated with non-cirrhotic portal vein thrombosis. J Hepatol. 2016;64(2):427–32.
19. Yang G, Staercke C, Hooper WC. The effects of obesity on venous thromboembolism : A review. Open J Prev Med. 2012;2(4):499–509.
20. Molina AR, Vílchez AR, Domínguez MB, García AN, San Miguel CM, González ARR, et al. Influence of Body Mass Index on Venous Thrombotic Complications of Liver Transplants. Transplant Proc. 2016;48(9):3017–20.
21. Ayala R, Grande S, Bustelos R, Ribera C, García-sesma A, Jimenez C, et al. Obesity is an independent risk factor for pre-transplant portal vein thrombosis in liver recipients. 2012;
22. Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, Ponziani F, et al. Thrombotic risk factors in patients with liver cirrhosis: Correlation with MELD scoring system and portal vein thrombosis development. J Hepatol. 2009;51(4):682–9.
23. Qi X, Su C, Ren W, Yang M, Jia J, Dai J, et al. Association between portal vein thrombosis and risk of bleeding in liver cirrhosis: A systematic review of the literature. Clin Res Hepatol Gastroenterol. 2015;39(6):683–91.
24. Yerdel MA, Gunson B, Mirza D, Karayalçin K, Olliff S, Buckels J, et al. Portal vein thrombosis in adults undergoing liver transplantation: Risk factors, screening, management, and outcome. Transplantation. 2000;69(9):1873–81.
25. Lladó L, Fabregat J, Castellote J, Ramos E, Torras J, Jorba R, et al. Management of portal vein thrombosis in liver transplantation: Influence on morbidity and mortality. Clin Transplant. 2007;21(6):716–21.
26. Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, et al. Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome. HPB (Oxford). 2007;9(5):352–6.
27. Ravaioli M, Zanello M, Grazi GL, Ercolani G, Cescon M, Gaudio M Del, et al. Portal vein thrombosis and liver transplantation: Evolution during 10 years of experience at the university of bologna. Ann Surg. 2011;253(2):378–84.
28. Pan C, Shi Y, Zhang JJ, Deng YL, Zheng H, Zhu ZJ, et al. Single-Center Experience of 253 Portal Vein Thrombosis Patients Undergoing Liver Transplantation in China. Transplant Proc. 2009;41(9):3761–5.
29. Francoz C, Valla D, Durand F. Portal vein thrombosis, cirrhosis, and liver transplantation. Vol. 57, Journal of Hepatology. 2012. p. 203–12.
30. Rai V. Haemostatic Profile of Patients with Chronic Liver Disease- its Correlation with Severity and Outcome. J Clin Diagnostic Res. 2017;11(8):24–6.
Related articles

Digestive Diseases Image

Posterior reversible encephalopathy syndrome (PRES) in post liver transplantation

DOI: 10.17235/reed.2022.8694/2022

Letter

Ertapenem neurotoxicity in liver transplantation

DOI: 10.17235/reed.2021.8469/2021

Digestive Diseases Image

Portal thrombosis in a patient with SARS-CoV-2 infection

DOI: 10.17235/reed.2021.8099/2021

Digestive Diseases Image

Percutaneous treatment of a splenorenal shunt with an atrial septal closure device

DOI: 10.17235/reed.2020.7701/2020

Review

Physical frailty in liver transplantation

DOI: 10.17235/reed.2020.7448/2020

Letter

Management of hepatic artery aneurysms

DOI: 10.17235/reed.2020.7219/2020

Digestive Diseases Image

Epithelioid hemangioendothelioma: a rare cause of a liver tumor

DOI: 10.17235/reed.2020.7127/2020

Letter to the Editor

Post-transplant lymphoproliferative disease after liver transplantation

DOI: 10.17235/reed.2017.5387/2017

Letter to the Editor

GETTEMO position statement on bariatric endoscopic techniques as a voluntary medicine

DOI: 10.17235/reed.2017.5144/2017

Letter to the Editor

Liver metastasis from colorectal cancer 12 years after liver transplantation

DOI: 10.17235/reed.2017.4507/2016

Original

Multicenter study on the safety of bariatric endoscopy

DOI: 10.17235/reed.2017.4499/2016

Citation tools
Reyes L, Herrero J, Rotellar Sastre F, Páramo J. Risk factors and impact of portal vein thrombosis in liver transplantation . 5819/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 634 visits.
This article has been downloaded 268 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 10/07/2018

Accepted: 28/11/2018

Online First: 25/04/2019

Published: 07/06/2019

Article revision time: 136 days

Article Online First time: 289 days

Article editing time: 332 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology