The Impact of Portal Vein Thrombosis on Liver Transplant Outcomes: Does Grade or Flow Rate Matter?
Rizzari MD, Safwan M, Sobolic M, Kitajima T, Collins K, Yoshida A, Abouljoud M, and Nagai S. The Impact of Portal Vein Thrombosis on Liver Transplant Outcomes: Does Grade or Flow Rate Matter? Transplantation 2020.
BACKGROUND: Portal vein thrombosis (PVT) makes the technical aspect of liver transplantation challenging and also affects outcomes. Our aim was to study impact of PVT grade and postreperfusion portal flow on posttransplant outcomes.
METHODS: Patients who underwent transplantation with PVT between January 2007 and May 2017 were selected (n=126). Data on grade of PVT and portal vein flow were collected. Patients were classified into 2 groups; low grade (Yerdel Grade I, n=73) and high grade (Yerdel Grade II or III, n=53). Using portal flow rate, patients were divided into high flow (≥1000 ml/min, n=95) and low flow (/min, n=31). Additional analyses of flow by graft weight and complications were performed.
RESULTS: Postoperatively, incidence of biliary strictures were significantly greater in high grade PVT compared to low grade (p=0.02). Incidence of postoperative portal vein thrombosis was higher in low flow after reperfusion compared to high flow (p=0.02), as was bile leak (p=0.02). On identifying factors associated with graft loss, moderate to severe ascites preoperatively, high PVT grade and bile leak were associated with worse graft survival. Subanalysis performed combining grade and flow showed that low grade, high flow had the highest graft survival while high grade, low flow had the lowest (p=0.006). High grade PVT with low flow also appeared to be an independent risk factor for biliary complications (p=0.01).
CONCLUSION: In conclusion, biliary complications, especially strictures are more common in high grade PVT and graft survival is worse in high grade PVT and low portal flow.
ePub ahead of print