Therapeutic anticoagulation after liver transplantation is not useful among patients with pre-transplant Yerdel-grade I/II portal vein thrombosis: A two-center retrospective study

Published on Aug 2, 2021in Journal of Thrombosis and Haemostasis5.824
· DOI :10.1111/JTH.15472
Isabel Bos , Marc Blondeau1
Estimated H-index: 1
(University of Rennes)
+ 9 AuthorsVincent E de Meijer24
Estimated H-index: 24
Sources
Abstract
BACKGROUND Portal vein thrombosis (PVT) is no longer a contraindication for liver transplantation (LT). While therapeutic anticoagulation (tAC) is recommended during the waiting period, there is no evidence for its usefulness in the prevention of PVT recurrence after LT. OBJECTIVES The aim of our study was to evaluate the role of tAC post-LT in the prevention of PVT recurrence. PATIENTS/METHODS All adult LTs performed in two high-volume centers between 2003 and 2018 were retrospectively analysed. Only patients with PVT classified as Yerdel grade I or II and with standard portal reconstruction were included. PVT recurrence and tAC-associated morbidity within 1 year were compared between patients receiving tAC or not. RESULTS During the study period, of 2612 LTs performed, 235 (9%) patients with PVT were included; 113 patients (48.1%) received post-LT tAC (tAC group) while 122 (51.9%) did not (non-tAC group). The incidence of bleeding events was significantly higher in the tAC group (26 [23%] vs. 5 [4.1%], P < .01) and the initial hospitalization duration was longer (21 vs. 17.5 days, P < .01). Within the first year, PVT recurrence was observed for 9 (3.8%) patients without any difference between the tAC and non-tAC groups (6 [5.1%] vs. 3 [2.5%], P = .39). The only identified risk factor for PVT recurrence was the recipients' age (odds ratio= 0.94, P = .03). Graft (P = .11) and patient (P = .44) survival were similar between the two groups. CONCLUSION Therapeutic anticoagulation is not necessary in the prevention of grade I/II PVT recurrence and is associated with higher morbidity and longer hospital stay.
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#1Peter Liou (CUMC: Columbia University Medical Center)H-Index: 8
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Thromboses of the hepatic and splanchnic vasculature, as both a cause and manifestation of end stage liver disease, represent some of the most formidable perioperative challenges for the transplant surgeon. Thomas Starzl's encounters with portal vein thrombosis (PVT) in the early era of liver transplantation and the resultant intraoperative deaths made PVT an absolute to relative contraindication to transplant for years1 .
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#1Michael Rizzari (HFH: Henry Ford Hospital)H-Index: 14
#2Mohamed Safwan (HFH: Henry Ford Hospital)H-Index: 10
Last. Shunji Nagai (HFH: Henry Ford Hospital)H-Index: 13
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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...
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#1Douglas A. Simonetto (Mayo Clinic)H-Index: 21
#2Ashwani K. Singal (USD: University of South Dakota)H-Index: 29
Last. Patrick S. Kamath (Mayo Clinic)H-Index: 83
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Disorders of the mesenteric, portal, and hepatic veins and mesenteric and hepatic arteries have important clinical consequences and may lead to acute liver failure, chronic liver disease, noncirrhotic portal hypertension, cirrhosis, and hepatocellular carcinoma. Although literature in the field of vascular liver disorders is scant, these disorders are common in clinical practice, and general practitioners, gastroenterologists, and hepatologists may benefit from expert guidance and recommendation...
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#1Prashant Bhangui (Medanta)H-Index: 17
#2Chetana LimH-Index: 22
Last. Daniel Azoulay (Sheba Medical Center)H-Index: 87
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Abstract Nontumoral PVT is present at liver transplantation in 5% to 26% of cirrhotic patients, and the prevalence of complex PVT as defined here (Grade 4 Yerdel, and Grade 3,4 Jamieson and Charco) has been reported in 0% to 2.2%. Adequate portal inflow is mandatory to ensure graft and patient survival after liver transplantation. With time, the proposed classifications of non-tumoral chronic PVT have evolved from being anatomy-based to also incorporating functional parameters. However, none of ...
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#2J. Tejedor-TejadaH-Index: 2
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Abstract Introduction Portal vein thrombosis (PVT) is a relatively common finding in patients undergoing liver transplantation. Although the recommendation to prevent its recurrence is anticoagulation for a duration of 3 to 6 months, this is controversial. Aim The aim of our study was to determine the efficacy of oral anticoagulants (OAC) as prophylaxis for recurrent PVT after liver transplantation. Materials and Methods Our study included 215 liver transplant patients who underwent surgery in o...
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: Thromboprophylaxis is not well defined after liver transplantation (LT). The aim of this study was to evaluate the incidence of splanchnic vein thrombosis (SVT) and nonsplanchnic vein thrombosis (NSVT) after LT. Liver transplantations performed between 2009 and 2013 in our institution were reviewed. Demographic, intraoperative, and postoperative data were recorded. Low-molecular-weight heparin was only administered postoperatively if intraoperative thrombectomy was performed or in patients pre...
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#2Jennifer Wang (UVA: University of Virginia)H-Index: 6
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#2Elizabeth A. Pomfret (University of Colorado Denver)H-Index: 54
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#1Mark M. DraouaH-Index: 1
#2Nicole Titze (UCI: University of California, Irvine)H-Index: 1
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Adequate portal vein (PV) flow in liver transplantation is essential for a good outcome, and it may be compromised in patients with portal vein thrombosis (PVT). This study evaluated the impact of intraoperatively measured PV flow after PV thrombendvenectomy on outcomes after deceased donor liver transplantation (DDLT). The study included 77 patients over a 16-year period who underwent PV thrombendvenectomy with complete flow data. Patients were classified into 2 groups: high PV flow (>1300 mL/m...
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