Nontumoral portal vein thrombosis in patients awaiting liver transplantation

Abstract

Portal vein thrombosis (PVT) occurs in about 2-26% of the patients awaiting liver transplantation (LT) and is no longer an absolute contraindication for LT. Nearly half of PVT cases are accidentally found during the LT procedure. The most important risk factor for PVT development in cirrhosis may be the severity of liver disease and reduced portal blood flow. Whether other inherited or acquired coagulation disorders play also a role is not clear yet. The development of PVT may have no effect on the liver disease progression, especially when it is non-occlusive. PVT may not increase the risk of waiting list mortality but is a risk factor for poor early post-LT mortality. Anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) are two major treatment strategies for patients with PVT in the waiting list. The complete recanalization rate after anticoagulation is about 40%. The role of TIPS to maintain PV patency for LT as the primary indication has been reported but the safety and efficacy should be further evaluated. PVT extension and degree may determine the surgical technique to be used during LT. If a “conventional” end-to-end portal anastomotic technique is used, there is no a major impact on post-LT survival. Post-LT PVT can significantly reduce both graft and patient survival after LT, and can preclude future options for re-LT.