*Purpose: The purpose of this study is to compare safety and efficacy outcomes in liver transplant recipients with portal vein thrombosis (PVT) at the time of liver transplantation who received anticoagulation versus those not anticoagulated for PVT.

*Methods: This study is a single-center retrospective analysis of liver transplant recipients with PVT at the time of transplantation. Patients included were 18 years of age or older who underwent liver transplantation at Intermountain Medical Center from January 2010 through June 2018 with PVT at time of transplant. Patients with a known clotting disorder or living donor liver transplant were excluded. Patients who received anticoagulation for PVT were compared to those not anticoagulated to determine differences in PVT resolution on repeat imaging within 6 months post-transplant (eg. Ultrasound, Computed Tomography). Secondary outcomes include major and minor bleeding, one-year patient and graft survival.

*Results: Forty-two patients were identified with PVT at the time of liver transplantation. Anticoagulation for PVT was initiated in 29 patients (69.0%) after transplantation. Resolution of PVT within 6 months post-transplant occurred in forty patients and was similar between those anticoagulated and not anticoagulated (93.1% vs 100%; p=0.375). The majority (93.3%) of patients demonstrated PVT resolution at one month post-transplant. No significant difference was seen in one-year graft survival (85.2% vs 80.0%; p=0.322) or one-year patient survival (88.5% vs 100%; p=0.545). There was no significant difference in major bleeding events (31.0% vs 30.8%; p=1.000) or minor bleeding events (17.2% vs 23.1%; p=0.503), however, two patients in the control group received anticoagulation for venous thromboembolism with three associated major bleeding events during the study period.

*Conclusions: Post-transplant anticoagulation in liver transplant recipients with PVT at the time of transplantation was not associated with higher frequency of resolution of PVT compared to those not receiving anticoagulation. While this study suggests no difference in bleeding events between groups, the risks of anticoagulation should be weighed against potential benefits.

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