Post reperfusion portal flow rate impacts liver allograft and patient survival in patients with pre transplant portal vein thrombosis

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Conference Proceeding

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Am J Transplant


Background: Pre-transplant (pretx) portal vein thrombosis (PVT) not only makes the technical aspect of liver transplantation more challenging, it also is known to affect outcomes. Few studies describe the impact of post reperfusion portal flow on liver transplant outcomes in the setting of pretx PVT. Methodology: Case records of all liver transplant recipients with pretx PVT from Jan 2010 to May 2017 (n=95) were reviewed. They were divided based on median portal flow after reperfusion into high (>1300 ml/min, n=47) and low group (≤1300 ml/min, n=48). Demographics and intraoperative characteristics were analyzed with postoperative outcomes. Results: Demographic characteristics were similar in both groups. Intraoperative factors such as cardiac output, central venous pressure, pulmonary artery pressure and transfusion requirements were also similar. Postoperatively, higher cumulative rates of biliary strictures at 6 months, 1 year and 2 years were observed in the low flow group compared to high flow group (29.6% Vs 10.8%, 37.8% Vs 10.8% and 40.7% Vs 13.5% respectively, p=0.008). Low flow group also had a higher rate of graft loss at any time period after transplant (HR 3.3, CI 1.07-10.31, p=0.038); and higher 3-year mortality risk (HR 9.3, CI 1.18-73.49, P=0.034). Incidence of postoperative PVT was similar in both groups (12.8% Vs 12.5%, p =1.0). Other postoperative outcomes like hepatic artery thrombosis, early allograft dysfunction, bile leak rates, early and late rejection rates and hospital stay were also similar. On multivariate analysis, low portal flow (HR 4.21, CI 1.26-14.02, p=0.019) and bile leak (HR 5.54, CI 1.95-15.78, p=0.001) were the only factors associated with worse graft survival. Pretx anticoagulation appeared to have a protective effect, though not statistically significant (HR 0.23, CI 0.03-1.76, p=0.16). Conclusions: Low portal flow after reperfusion in the setting of pretx PVT may be an independent negative predictor of allograft survival and patient survival. Post-transplant bile leak may a negative predictor for allograft survival. Pretx anticoagulation in the setting of PVT appears to have some protective effects on graft survival.




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