Abstract
Non-tumoral portal vein thrombosis (PVT) is associated with higher morbidity and mortality in liver transplantation (LT). In this study, we aimed to evaluate the impact of PVT in LT outcomes and analyze the types of surgical techniques used for dealing with PVT during LT.A systematic review was conducted in Cochrane, MEDLINE, and EMBASE databases, selecting articles from January 1990 to December 2019. The MESH-terms used were (“Portal Vein”[Mesh] AND “Thrombosis”[Mesh] NOT “Neoplasms”[Mesh]) AND (“Liver Transplantation”[Mesh]). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendation was used, and meta-analysis was performed with Review Manager Version 5.3 software.A total of 1,638 articles were initially found: 488 in PubMed, 289 in Cochrane Library, and 861 in EMBASE, from which 27 were eventually selected for the meta-analysis. Surgery time of LT in patients with PVT was longer than in patients without LT (p<0.0001). Intraoperative red blood cell (p<0.00001), fresh frozen plasma (p=0.01), and platelets (p=0.03) transfusions during LT were higher in patients with PVT. One-year (odds ratio [OR] 1.17; p=0.002) and 5-year (OR 1.12; p=0.01) patient survival after LT was worse in the PVT group. Total occlusive PVT presented higher mortality (OR 3.70; p=0.00009) and rethrombosis rates (OR 3.47 [1.18-10.21]; p=0.02). PVT Yerdel III/IV classification exhibited worse 1-year [2.04 (1.21-3.42); p=0.007] and 5-year [0.98 (0.59-1.62); p=0.93] patient survival. Thrombectomy with primary anastomosis was associated with better outcomes.LT in patients with non-tumoral PVT demands more surgical time, needs more intraoperative transfusion, and presents worse 1- and 5-year patient survival. Total occlusive PVT and Yerdel III/IV PVT classification were associated with higher mortality. (PROSPERO, registration number: CRD42020132915).
Highlights
Non-tumoral portal vein thrombosis (PVT) is a relevant condition in liver cirrhosis evolution, with an estimated incidence rate of 0.7 per 100,000 and prevalence ranging from 0.6-28% in cirrhotic patients (1-3)
The New Castle-Ottawa Scale (NOS) qualification of the studies for non-tumoral PVT in liver transplantation (LT) and the overall demographics data of selected studies are depicted in Tables 1 and 2, respectively
Thrombectomy was performed in 932 patients, superior mesenteric vein (SMV) jump graft in 95, interposition vein graft in 23, collateral anastomosis in 32, renoportal anastomosis in 27, and cavoportal hemitransposition (CPH) in 50 (Table 2)
Summary
Non-tumoral portal vein thrombosis (PVT) is a relevant condition in liver cirrhosis evolution, with an estimated incidence rate of 0.7 per 100,000 and prevalence ranging from 0.6-28% in cirrhotic patients (1-3). It is well-established that patients with severe cirrhosis (Child-Pugh C Classification) have a high incidence of PVT (4). Received for publication on July 1, 2020. Accepted for publication on November 13, 2020
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call