Portal Vein Thrombosis Discovered at Liver Transplant: Barrier to Success
1Mercer University Medical School, Macon, GA, 2Transplantation, Piedmont Transplant Institute, Atlanta, GA, 3Piedmont Heart Institute, Atlanta, GA
Meeting: 2019 American Transplant Congress
Abstract number: A318
Keywords: Liver transplantation, Outcome, Portal veins, Surgical complications
Session Information
Date: Saturday, June 1, 2019
Session Name: Poster Session A: Liver: Recipient Selection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: Portal vein thrombosis (PVT) present at listing or diagnosed while listed enables potential treatment pre-liver transplant (OLT). Main PVT at OLT (mPVT) complicates surgeries and diminishes outcomes. PVT discovered at transplant (dPVT) may be more problematic. The purpose of this study was to define predictors of dPVT and to assess the impact of dPVT on outcomes.
*Methods: Single center retrospective review of clinical data in all patients with OLT 1/1/15-7/29/17. Univariate and multivariate analyses compared patients with dPVT vs. without mPVT.
*Results: 266 patients had OLT. 30 (11.3%) patients had PVT; 6 with PVT before but not at OLT and 1 with new PVT after OLT were excluded. 23 patients had mPVT; 12 known before and confirmed at OLT and 11 dPVT. There were no statistically significant associations between predictor variables (sex, age, race, BMI, cancer, NASH primary indication, diabetes mellitus, pre-OLT MELD-Na, INR or platelets) and dPVT. BMI < 18.5 kg/m2and longer time between imaging and OLT had a higher probability of dPVT in multivariate analyses. 0/11 with dPVT vs. 47/236 (20.0%) without mPVT had TIPS. 7/11 with dPVT had contrast CT or MR < 4 months before OLT; 5/11 had doppler US 12±2.7 days before OLT with portal vein velocity 20± 7.1cm/s. 1/11 with dPVT was on pre-OLT ASA. 9/11 with dPVT had thrombectomy at OLT.
| Outcome | No mPVT (n=236) | dPVT (n=11) | p VALUE |
| Surgical | |||
| Warm ischemia (minutes) | 32.47±20.04 | 39.55±7.83 | <0.01 |
| Total ischemia (minutes) | 329.5±101.30 | 412.70±121.10 | 0.34 |
| FFP (U) | 3.02±3.20 | 9.36±10.89 | <0.01 |
| RBC (U) | 3.43±3.64 | 8.82±11.67 | <0.01 |
| Cell saver (L) | 0.89±1.48 | 2.01±3.27 | <0.01 |
| Overall | |||
| 1-year survival | 93.6% | 72.7% | 0.04 |
There were 0 biliary leaks and 3 take backs with dPVT. After OLT, 8 got ASA (1 also warfarin), 10 SQ heparin, 1 no anti-coagulant. 3 had bleeding (2 intra-abdominal, 1 transfusion for anemia). 2 died during the transplant admission. 7 with dPVT were on ASA (1 also warfarin) 30 days after OLT. None had recurrent PVT after OLT.
*Conclusions: 4.1% of transplants had dPVT despite robust radiologic monitoring. Low portal vein velocities presaged dPVT in a few patients. Low BMI and longer interval between imaging and OLT were associated with dPVT. No other predictors of dPVT were identified, perhaps due to sample size. dPVT was associated with longer warm and total ischemic times, take backs, and worse survival. Larger studies are needed to define whether more aggressive pre-operative surveillance and treatment of PVT would reduce mPVT and dPVT and improve outcomes.
To cite this abstract in AMA style:
Seltman J, Kazimi M, Duque J, Cross R, Ray A, Ommert T, Rubin RA. Portal Vein Thrombosis Discovered at Liver Transplant: Barrier to Success [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/portal-vein-thrombosis-discovered-at-liver-transplant-barrier-to-success/. Accessed February 27, 2020.« Back to 2019 American Transplant Congress