OJOTS  Vol.1 No.1 , August 2011
Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?
Abstract: Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more post-operative thrombotic events than those without PVT. Aims: To compare rates of post-op thrombotic events and outcomes between those with and without pre-op PVT. Methods: All OLT recipients between 1/02-4/09 were retrospectively reviewed. Outcome measures included survival, deep venous thrombosis, pulmonary embolism, hepatic artery thrombosis, and recurrent PVT. Minimum follow up was 6 months. Results: In 363 OLTs performed, mean recipient age was 53.1 yrs (±9.2); 268 patients were male. Mean MELD at transplant was 22.1 (±6.2). The prevalence of pre-op PVT was 11.2% (41/350). There was no difference in the % of post-op thrombotic events between those with and without PVT (p = 0.77). MELD, recipient and donor age, and gender were similar in both groups. Mean survival in those with pre-op PVT was 85.2 months vs. 78.7 in those without PVT (p = 0.19). Conclusions: The rate of post-op thrombotic events was equivalent in OLT recipients with and without pre-op PVT. The presence of PVT did not adversely impact patient survival and should not be a contraindication to OLT.
Cite this paper: nullEnestvedt, B. , Enestvedt, C. , Diggs, B. and Orloff, S. (2011) Hypercoagulability in Liver Transplant Recipients: Does Portal Vein Thrombosis Predict Post-Operative Thrombotic Complications?. Open Journal of Organ Transplant Surgery, 1, 1-7. doi: 10.4236/ojots.2011.11001.

[1]   M. Ogren, D. Bergqvist, M. Bjorck, S. Acosta, H. Eriksson and N. H. Sternby, “Portal Vein Thrombosis: Prevalence, Patient Characteristics and Lifetime Risk: A Population Study Based on 23,796 Consecutive Autopsies,” World Journal of Gastroenterology, Vol. 12, No. 13, 2006, pp. 2115-2119.

[2]   B. R. Davidson, M. Gibson, R. Dick, A. Burroughs and K. Rolles, “Incidence, Risk Factors, Management, and Outcome of Portal Vein Abnormalities at Orthotopic Liver Transplantation,” Transplantation, Vol. 57, No. 8, 1994, pp. 1174-1177. doi:10.1097/00007890-199404270-00006

[3]   E. A. Tsochatzis, M. Senzolo, G. Germani, A. Gatt and A. K. Burroughs, “Systematic Review: Portal Vein Thrombosis in Cirrhosis,” Alimentary Pharmacology and Therapeutics, Vol. 31, No. 3, 2010, pp. 366-374. doi:10.1111/j.1365-2036.2009.04182.x

[4]   L. Amitrano, V. Brancaccio, M. A. Guardascione, et al., “Inherited Coagulation Disorders in Cirrhotic Patients with Portal Vein Thrombosis,” Hepatology, Vol. 31, No. 2, 2000, pp. 345-348. doi:10.1002/hep.510310213

[5]   L. Amitrano, M. A. Guardascione, V. Brancaccio, et al., “Risk Factors and Clinical Presentation of Portal Vein Thrombosis in Patients with Liver Cirrhosis,” Journal of Hepatology, Vol. 40, No. 5, 2004, pp. 736-741. doi:10.1016/j.jhep.2004.01.001

[6]   G. Manzanet, F. Sanjuan, P. Orbis, et al., “Liver Transplantation in Patients with Portal Vein Thrombosis,” Liver Transplantation, Vol. 7, No. 2, 2001, pp. 125-131. doi:10.1053/jlts.2001.21295

[7]   T. Nonami, I. Yokoyama, S. Iwatsuki and T. E. Starzl, “The Incidence of Portal Vein Thrombosis at Liver Transplantation,” Hepatology, Vol. 16, No. 5, 1992, pp. 1195-1198. doi:10.1002/hep.1840160515

[8]   A. Shaked and R. W. Busuttil, “Liver Transplantation in Patients with Portal Vein Thrombosis and Central Portacaval Shunts,” Annals of Surgery, Vol. 214, No. 6, 1991, pp. 696-702. doi:10.1097/00000658-199112000-00009

[9]   A. C. Stieber, G. Zetti, S. Todo, et al., “The Spectrum of Portal Vein Thrombosis in Liver Transplantation,” Annals of Surgery, Vol. 213, No. 3, 1991, pp. 199-206. doi:10.1097/00000658-199103000-00003

[10]   M. J. Englesbe, J. Kubus, W. Muhammad, et al., “Portal Vein Thrombosis and Survival in Patients with Cirrhosis,” Liver Transplantation, Vol. 16, No. 1, 2010, pp. 83-90. doi:10.1002/lt.21941

[11]   M. H. Denninger, Y. Chait, N. Casadevall, et al., “Cause of Portal or Hepatic Venous Thrombosis in Adults: The Role of Multiple Concurrent Factors,” Hepatology, Vol. 31, No. 3, 2000, pp. 587-591. doi:10.1002/hep.510310307

[12]   H. L. Janssen, J. R. Meinardi, F. P. Vleggaar, et al., “Factor V Leiden Mutation, Prothrombin Gene Mutation, and Deficiencies in Coagulation Inhibitors Associated with Budd-Chiari Syndrome and Portal Vein Thrombosis: Results of a Case-Control Study,” Blood, Vol. 96, No. 7, 2000, pp. 2364-2368.

[13]   D. C. Valla and B. Condat, “Portal Vein Thrombosis in Adults: Pathophysiology, Pathogenesis and Management,” Journal of Hepatology, Vol. 32, No. 5, 2000, pp. 865-871. doi:10.1016/S0168-8278(00)80259-7

[14]   M. den Heijer, T. Koster, H. J. Blom, et al., “Hyperhomo- cysteinemia as a Risk Factor for Deep-Vein Thrombosis,” New England Journal of Medicine, Vol. 334, No. 21, 1996, pp. 759-762. doi:10.1056/NEJM199603213341203

[15]   M. A. Avila, C. Berasain, L. Torres, et al., “Reduced mRNA Abundance of the Main Enzymes Involved in Methionine Metabolism in Human Liver Cirrhosis and Hepatocellular Carcinoma,” Journal of Hepatology, Vol. 33, No. 6, 2000, pp. 907-914. doi:10.1016/S0168-8278(00)80122-1

[16]   M. R. Gomez, E. S. Garcia, D. L. Lacomba, I. Marchante, L. Grande, M. C. Fernandez, “Anti-phospholipid Anti- bodies are Related to Portal Vein Thrombosis in Patients with Liver Cirrhosis,” Journal of Clinical Gastroenterology, Vol. 31, No. 3, 2000, pp. 237-240. doi:10.1097/00004836-200010000-00011

[17]   F. Dentali, M. Galli, M. Gianni and W. Ageno, “Inherited Thrombophilic Abnormalities and Risk of Portal Vein Thrombosis: A Meta-analysis,” Thromb Haemost, Vol. 99, No. 4, 2008, pp. 675-682.

[18]   G. J. Webster, A. K. Burroughs, S. M. Riordan, “Review Article: Portal Vein Thrombosis - New Insights into Aetiology and Management,” Alimentery Pharmacology and Therapeutics, Vol. 21, No. 1, 2005, pp. 1-9. doi:10.1111/j.1365-2036.2004.02301.x

[19]   J. P. Duffy, J. C. Hong, D. G. Farmer, et al., “Vascular Complications of Orthotopic Liver Transplantation: Experience in More than 42,000 Patients,” Journal of the American College of Surgeons, Vol. 208, No. 5, 2009, pp. 896-903.

[20]   E. P. Molmenti, et al., “Thrombendvenectomy for Organized Portal Vein Thrombosis at the Time of Liver Transplantation,” Annals of Surgery, Vol. 235, 2002, pp. 292-296. doi:10.1097/00000658-200202000-00019

[21]   J. Dumortier, et al., “Eversion Thrombectomy for Portal Vein Thrombosis during Liver Transplantation,” American Journal of Transplantation, Vol. 2, No. 10, 2002, pp. 934-938. doi:10.1097/00000658-200202000-00019

[22]   J. Neugarten and S. R. Silbiger, “The Impact of Gender on Renal Transplantation,” Transplantation, Vol. 15, 1994, pp. 1145-1152. doi:10.1097/00007890-199412150-00001

[23]   J. Neugarten, T. Srinivas, V. Tellis, S. R. Silbiger and S. Greenstein, “The Effect of Donor Gender on Renal Allograft Survival,” Journal of the American Society of Nephrology, Vol. 7, No. 2, 1996, pp. 318-324.

[24]   P. Vereerstraeten, M. Wissing, L. DePauww and D. K. Abramowicz, “Male Recipients of Kidneys from Female Donors are at Increased Risk of Graft Loss from Both Rejection and Technical Failure,” Clinical Transplantation, Vol. 13, 1999, pp. 181-186. doi:10.1034/j.1399-0012.1999.130205.x

[25]   M. Zeier, B. Dohler, G. Opelz and E. Ritz, “The Effect of Donor Gender on Graft Survival,” Journal of the American Society of Nephology, Vol. 13, No. 10, 2002, pp. 2570-2576. doi:10.1097/01.ASN.0000030078.74889.69

[26]   M. Hertl, J. F. Markmann, P. S. Russell and H. Yeh, “Liver Transplantation,” Merck Manual, Sept 2008.

[27]   D. Kahn, J. S. Gavaler, L. Makowka, D. H. van Thiel, “Gender of Donor Influences Outcome after Orthotopic Liver Transplant in Adults,” Digestive Diseases and Sciences, Vol. 38, No. 8, 1993, pp. 1485-1488. doi:10.1007/BF01308608