Portal vein thrombosis and outcomes for pediatric liver transplant candidates and recipients in the United States

Abstract

The effect of occlusive portal vein thrombosis (PVT) on the mortality of pediatric liver transplant candidates and recipients is poorly defined. Using standard multivariate techniques, we studied the relationship between PVT and waiting-list and posttransplant survival rates with data from the Scientific Registry of Transplant Recipients (September 2001 to December 2007). In all, 5087 liver transplant candidates and 3630 liver transplant recipients were evaluated during the period. PVT was found in 1.4% of the liver transplant candidates (n = 70) and in 3.7% of the liver transplant recipients (n = 136). PVT was not associated with increased wait-list mortality [hazard ratio (HR) = 1.1, 95% confidence interval (CI) = 0.5-2.4, P = 0.77]. Conversely, PVT patients had a significantly lower unadjusted survival rate in the posttransplant period (P = 0.01). PVT was independently associated with increased posttransplant mortality in multivariate models (30-day survival: HR = 2.9, 95% CI = 1.6-5.3, P = 0.001; overall survival: HR = 1.7, 95% CI = 1.1-2.4, P = 0.01). The presence of PVT in pediatric liver candidates was not associated with increased wait-list mortality but was clearly associated with posttransplant mortality, especially in the immediate postoperative period.