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Original Article

Portal vein thrombosis in liver transplantation: radiologic

evaluation, risk factors, and occult diagnosis

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Adam Hauch , Carl Winkler , Eric Katz , Peter W. Lundberg , Mary Killackey , Anil S.
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Paramesh , Luis A. Balart , Nathan J. Shores , Martin Moehlen , Ward Miller , Douglas P.
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Slakey , Joseph F. Buell , Bob H. Saggi 1
1 Tulane Transplant Institute, Tulane University School of Medicine, New Orleans, LA 70112, USA
2 Department of Gastroenterology, Section of Hepatology, Tulane University School of Medicine, New Orleans, LA 70112, USA
ABSTRACT
Aim: Portal vein thrombosis (PVT) in the liver transplant recipient poses many challenges. Unfortunately, the risk
factors and effects on outcomes of PVT are not well-defined. Methods: This study analyzed the experience with
PVT in liver transplant program from 2007 to 2013. This included the effectiveness of PVT diagnostics and its risk
factors using logistical regression. The primary endpoints were Kaplan-Meir patient and graft survival. The secondary
endpoints were the length of stay (LOS), transfusion rate, and overall morbidity. Independent predictors of survival were
identified using a Cox’s proportional hazards model. Results: Two hundred and sixteen consecutive liver transplant
recipients were examined, and 30 (13.8%) had either a total or partial PVT. Two hundred and five patients had imaging
within 1 year of liver transplantation with only 7 (23.3%) of the 30 PVTs identified pre-operatively. Calculated sensitivity
(4.8-50%) and negative predictive values (10.5-22.2%) were poor. Only, age significantly predicted PVT [P = 0.037/hazard
ratio (HR) =0.95]. Ninety-day-patient and graft survival for PVT was similar at 6 months, although 1-year survival was
significantly lower. “Occult” PVT was not associated with inferior survival. Model for end-stage liver disease score >
25 (P = 0.001, HR = 0.49/P = 0.004, HR = 0.52) and age > 60 years (P = 0.017, HR = 0.64/P = 0.013, HR = 0.67) were
significant predictors of patient and graft survival. Although the transfusion rate was significantly greater with PVT,
LOS, and morbidity were not. Conclusion: Older recipients had a greater likelihood of PVT. Diagnostic studies were
not effective at excluding PVT, and occult diagnosis did not affect the outcome. PVT was not an independent predictor
of mortality or graft loss, but was associated with greater blood loss but not increased LOS or morbidity.
Key words: Advanced age; graft survival; patient survival; post-transplant outcomes; resource utilization

Address for correspondence:
Dr. Adam Hauch, Tulane Transplant Institute, Tulane University School of Medicine, 1415 Tulane Ave. HC-5, New Orleans, LA 70112, USA. E-mail:
ahauch@tulane.edu
Received: 23-04-2015, Accepted: 06-09-2015

Adam Hauch received his undergraduate degree in Mathematics at Northwestern University. He then went on to
receive his medical and business degrees from the University of Southern California. He is currently in his fourth
clinical year of general surgery residency at Tulane University where he is also actively involved in both clinical
and basic science research.

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How to cite this article: Hauch A, Winkler C, Katz E, Lundberg PW,
Killackey M, Paramesh AS, Balart LA, Shores NJ, Moehlen M, Miller
DOI: W, Slakey DP, Buell JF, Saggi BH. Portal vein thrombosis in liver
10.4103/2394-5079.168070 transplantation: radiologic evaluation, risk factors, and occult diagnosis.
Hepatoma Res 2016;2:36-41.

36 © 2016 Hepatoma Research | Published by OAE Publishing Inc.