Portal vein thrombosis in cirrhotic patients awaiting liver transplantation

Abstract

Introduction: The development of portal vein thrombosis (PVT) in cirrhotic patients awaiting liver transplantation is unclear. PVT not only aggravates liver function but also challenges liver transplantation techniques. We aimed to investigate possible predictive factors relating with PVT and the outcome after liver transplantation (LT). Method: From January 2013 to December 2015, a total of 349 cirrhotic patients who were awaiting liver transplantation were included. PVT is defined by radiology-revealed filling defect in portal vein (PV) in all patients. Of the patients had liver transplantation, PV was confirmed with a PV thrombus during operation. We have assessed the correlation of the development of portal vein thrombosis (PVT, n=48) and the opposite group (non-PVT, n=301) with clinicopathologic features by Pearson’s chi-squared test. Univariate and multivariate analyses were carried out to identify independent risk factors, followed by survival analysis. Result: Forty-eight (13.8%) among all patients had PVT. The average MELD score was 16.4±7.5. Presence of esophageal varices (EV), a positive EV bleeding history, INR prolongation, thrombocytopenia and relative deficiency of protein C and protein S level were observed for patients with PVT. Eighteen of forty-eight patients and 145 of 301 patients received liver transplantation in PVT and non-PVT group, respectively. Multivariate analysis demonstrated low protein S level (P= 0.017, HR= 2.46, 95% CI=1.17-5.46) as the only independent risk factor for PVT development. Protein S deficiency demonstrated prognostic value on short-term survival, not only for cirrhotic patient awaiting LT (1-year OS: 69.9 v.s 84.1%, p=0.012), but also for whom after LT (1-year OS: 70.4 v.s 84.8%, p=0.047). Conclusion: In cirrhotic patients awaiting LT, PVT development cause lots of clinical complexity and surgical challenges. Protein S deficiency not only correlates with PVT but also acts as an indicative prognostic factor independently. We suggest early LT for certain cases for a better Result.