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studies, along with a multicenter pooling and analysis of data 7. Yerdel MA, Gunson B, Mirza D, Karayalcin K, Olliff S, Buckels J, Mayer
would be a key to providing insight into this area. D, McMaster P, Pirenne J. Portal vein thrombosis in adults undergoing
liver transplantation: risk factors, screening, management, and outcome.
Transplantation 2000;69:1873-81.
Not only is PVT thought to increase post-transplant mortality, 8. Davidson BR, Gibson M, Dick R, Burroughs A, Rolles K. Incidence,
but morbidity has been argued by some to be affected risk factors, management, and outcome of portal vein abnormalities at
as well. PVT has been associated with increased risk of orthotopic liver transplantation. Transplantation 1994;57:1174-7.
sepsis, [6,22-25] gastrointestinal bleeding due to persistent portal 9. Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, Quarin
hypertension, [4,21,22,24,25] ascites, renal dysfunction, [4,24] and C, Garay V, Imventarza O. Liver transplantation in adult patients with
thrombotic events such as thrombosis at the anastomosis, portal vein thrombosis: risk factors, management and outcome. HPB
(Oxford) 2007;9:352-6.
hepatic artery, and pulmonary embolism. [24,25] This may reflect 10. Francoz C, Belghiti J, Vilgrain V, Sommacale D, Paradis V, Condat
the greater technical difficulty in the operation, the advanced B, Denninger MH, Sauvanet A, Valla D, Durand F. Splanchnic vein
disease state of patients with PVT, or a combination of the thrombosis in candidates for liver transplantation: usefulness of screening
two. In our series, PVT was not an independent determinant of and anticoagulation. Gut 2005;54:691-7.
survival. Our data suggest that it is the advanced age and more 11. Dumortier J, Czyglik O, Poncet G, Blanchet MC, Boucaud C, Henry L,
advanced liver disease in patients with PVT that contributes to Boillot O. Eversion thrombectomy for portal vein thrombosis during liver
transplantation. Am J Transplant 2002;2:934-8.
reduced patient and graft survival. Furthermore, we found that 12. Wai H, Stepanova M, Saab S, Erario M, Srishord M, Younossi ZM.
PVT was only associated with greater blood loss. Aside from Inpatient economic and mortality assessment for liver transplantation:
blood loss, PVT did not contribute significantly to resource a nationwide study of the United States data from 2005 to 2009.
utilization, as measured by LOS or post-operative morbidity. Transplantation 2014;97:98-103.
[14]
These data are encouraging but need to be combined with 13. Suarez Artacho G, Barrera Pulido L, Alamo Martinez JM, Serrano Diez-
larger patient series to establish more generalizable data. Canedo J, Bernal Bellido C, Marín Gomez LM, Padillo Ruiz J, Gómez
Bravo MA. Outcomes of liver transplantation in candidates with portal
vein thrombosis. Transplant Proc 2010;42:3156-8.
In conclusion, neither patient or graft survival nor resource 14. Agopian VG, Kaldas FM, Hong JC, Whittaker M, Holt C, Rana A,
utilization in the form of LOS or overall post-operative Zarrinpar A, Petrowsky H, Farmer D, Yersiz H, Xia V, Hiatt JR, Busuttil
morbidity was adversely affected by a known diagnosis or an RW. Liver transplantation for nonalcoholic steatohepatitis: the new
occult finding of PVT in LT at our center. However, PVT at the epidemic. Ann Surg 2012;256:624-33.
time of LT did result in increased blood loss. Although this 15. Cherqui D, Duvoux C, Rahmouni A, Rotman N, Dhumeaux D, Julien
probably affected cost, it did not affect LOS or morbidity in our M, Fagniez PL. Orthotopic liver transplantation in the presence of partial
or total portal vein thrombosis: problems in diagnosis and management.
series. These results are reassuring given the poor sensitivity World J Surg 1993;17:669-74.
and negative predictive value of current imaging. The data 16. Molmenti EP, Roodhouse TW, Molmenti H, Jaiswal K, Jung G, Marubashi
from our study indicate that an extensive search for PVT may S, Sanchez EQ, Gogel B, Levy MF, Goldstein RM, Fasola CG, Elliott EE,
not be warranted, and imaging should be ordered only when Bursac N, Mulligan D, Gonwa TA, Klintmalm GB. Thrombendvenectomy
otherwise indicated (e.g., malignancy surveillance and known for organized portal vein thrombosis at the time of liver transplantation.
Ann Surg 2002;235:292-6.
malignancy). Clinical suspicion for PVT should be high in older 17. Tao YF, Teng F, Wang ZX, Guo WY, Shi XM, Wang GH, Ding GS, Fu
patients, especially with a high MELD score and/ or ICU status. ZR. Liver transplant recipients with portal vein thrombosis: a single center
By optimization of the patient and anticipatory anesthesia retrospective study. Hepatobiliary Pancreat Dis Int 2009;8:34-9.
care, the patient may benefit by a reduction in blood loss. 18. Englesbe MJ, Schaubel DE, Cai S, Guidinger MK, Merion RM. Portal
vein thrombosis and liver transplant survival benefit. Liver Transpl
2010;16:999-1005.
Financial support and sponsorship 19. Manzanet G, Sanjuán F, Orbis P, López R, Moya A, Juan M, Vila J, Asensi
Nil. J, Sendra P, Ruíz J, Prieto M, Mir J. Liver transplantation in patients with
portal vein thrombosis. Liver Transpl 2001;7:125-31.
Conflicts of interest 20. Bertelli R, Nardo B, Montalti R, Beltempo P, Puviani L, Cavallari A. Liver
There are no conflicts of interest. a single transplant center. Transplant Proc 2005;37:1119-21.
21. Paskonis M, Jurgaitis J, Mehrabi A, Kashfi A, Fonouni H, Strupas K,
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