Clinical Determinants and Impact of Non-Tumoral Portal Vein Thrombosis among liver transplant candidates

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-09-01 DOI:10.1016/j.dld.2025.08.038

S. Parisse , F. Ferri , M. Carlucci , M. Corona , A. De Santis , P. Lucatelli , F. Melandro , G. Mennini , M. Rossi , S. Ginanni Corradini

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Abstract

Background and Aims

Portal vein thrombosis (PVT) is common among liver transplant (LT) candidates, and often associated with advanced cirrhosis. When severe, PVT may be a contraindication to LT. Metabolic syndrome features are increasingly prevalent in these patients and merit careful assessment. This study evaluates clinical factors associated with PVT in LT candidates and its effect on access to the LT waiting list (WL) and transplantation.

Method

711 consecutive patients assessed for LT (2008–2020) were retrospectively enrolled. Data included PVT presence and severity (Yerdel classification) and clinical variables. Reasons for listing exclusion and WL drop-out were also recorded. Multivariate binary logistic regression with backward selection and bootstrap was used, with PVT presence, WL access, and LT as dependent variables and clinically relevant factors as covariates.

Results

PVT was found in 11.6% of patients (n=83), with advanced PVT (Yerdel 3–4) in 28.6% of cases. 278 patients (39%) were listed, with 171 undergoing LT (61%). Obesity was the only independent factor associated with PVT (p=0.002, OR 2.619, 95% CI 1.577–4.352), adjusted for age, MELD, hepatocellular carcinoma, diabetes, hypertension, dyslipidemia. Patients with PVT were more often excluded from listing for clinical contraindications than those without PVT (26% vs 14%, p=0.04). However, multivariate analysis found no independent association between PVT and WL access or LT. Advanced PVT was more frequent in non-transplanted PVT patients than transplanted ones (40% vs 20%, p=0.04). No significant differences emerged in WL drop-out causes.

Conclusion

Among LT candidates, obesity is strongly associated with PVT, likely reflecting pro-inflammatory and pro-thrombotic gut-liver axis effects. Access to the WL and LT is probably affected by multiple factors, which can explain why PVT was not found to be significant. However, PVT is often observed in patients excluded from listing for clinical contraindications, likely associated with coexisting obesity, and, when advanced, reduces access to LT.

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肝移植候选者非肿瘤性门静脉血栓形成的临床决定因素和影响

背景和目的门静脉血栓形成（PVT）在肝移植（LT）候选人中很常见，通常与晚期肝硬化相关。严重时，PVT可能是lt的禁忌症。代谢综合征特征在这些患者中越来越普遍，值得仔细评估。本研究评估了与肝移植候选者PVT相关的临床因素及其对肝移植等待名单（WL）和移植的影响。方法回顾性纳入711例连续接受LT评估的患者（2008-2020）。数据包括PVT的存在和严重程度（Yerdel分类）和临床变量。此外，还记录了被排除在名单之外和被淘汰的原因。采用反向选择和自举的多元二元logistic回归，以PVT存在、WL通路和LT为因变量，临床相关因素为协变量。结果11.6%（83例）的患者存在spvt， 28.6%的患者存在晚期PVT （Yerdel 3-4）。278例患者（39%）入选，171例患者接受了肝移植（61%）。肥胖是唯一与PVT相关的独立因素（p=0.002, OR 2.619, 95% CI 1.577-4.352），经年龄、MELD、肝细胞癌、糖尿病、高血压、血脂异常校正后。有PVT的患者比没有PVT的患者更常被排除在临床禁忌症名单之外（26%比14%，p=0.04）。然而，多变量分析发现PVT与WL通路或lt之间没有独立的关联。晚期PVT在未移植PVT患者中比移植PVT患者更常见（40%比20%，p=0.04）。WL退出原因无显著差异。结论：在LT候选人中，肥胖与PVT密切相关，可能反映了促炎症和促血栓形成的肠-肝轴效应。进入WL和LT可能受到多种因素的影响，这可以解释为什么PVT没有被发现显着。然而，PVT经常在被排除在临床禁忌症名单之外的患者中观察到，可能与共存的肥胖有关，并且当进展时，减少了肝移植的可及性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.