Research and Development, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington.
Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington.
Clin Gastroenterol Hepatol. 2015 Mar;13(3):585-93. doi: 10.1016/j.cgh.2014.10.010. Epub 2014 Oct 18.
BACKGROUND & AIMS: Portal vein thrombosis (PVT) is common in patients with cirrhosis and may have adverse clinical consequences. We investigated whether PVT is associated with survival in patients with cirrhosis.
Using the United Network for Organ Sharing registries from 2002 through 2013, we followed a cohort of transplant-naive adults with cirrhosis without hepatocellular carcinoma (N = 66,506) from the time of transplant listing until the time of liver transplantation or death before transplantation. We used Cox proportional hazards analysis and competing risks analysis to compare patients who had PVT at the time of listing (n = 2207) with those who did not (n = 64,299) with regard to the risk of transplantation or death before transplantation, after adjusting for important baseline characteristics.
During a mean follow-up period of 1.78 years, 17,757 (27%) patients died before liver transplantation, 29,179 (44%) patients underwent transplantation, and 19,570 (29%) patients were still alive without having undergone transplantation. Compared with patients who did not have PVT, patients with PVT had lower mortality (adjusted hazard ratio [AHR], 0.88; 95% confidence interval [CI], 0.81-0.96), a similar risk of transplantation (AHR, 0.95; 95% CI, 0.89-1.02), and a lower risk of the combined outcome of death or transplantation (AHR, 0.92; 95% CI, 0.88-0.97). Similar results were found by competing risks analyses. Independent predictors of mortality included age, model for end-stage liver disease score, serum albumin level, ascites, encephalopathy, diabetes, hepatitis C virus infection, and low body mass index (<24.4 kg/m(2)).
Among patients with cirrhosis on liver transplant waiting lists, patients with PVT have lower mortality than patients without PVT.
门静脉血栓形成（PVT）在肝硬化患者中较为常见，可能会产生不良的临床后果。本研究旨在探讨 PVT 是否与肝硬化患者的生存相关。
我们使用 2002 年至 2013 年期间美国器官共享联合网络的注册数据库，对无肝细胞癌的肝移植初治成年肝硬化患者队列（n=66506）进行了随访，随访时间从肝移植名单登记到肝移植或名单登记前死亡。我们使用 Cox 比例风险分析和竞争风险分析比较了名单登记时患有 PVT（n=2207）和未患有 PVT（n=64299）患者在名单登记前发生肝移植或死亡的风险，调整了重要的基线特征。
在平均 1.78 年的随访期间，17757（27%）名患者在肝移植前死亡，29179（44%）名患者接受了肝移植，19570（29%）名患者仍然存活但未接受肝移植。与无 PVT 的患者相比，有 PVT 的患者死亡率更低（校正风险比[AHR]，0.88；95%置信区间[CI]，0.81-0.96），肝移植风险相似（AHR，0.95；95%CI，0.89-1.02），死亡或移植的联合结局风险较低（AHR，0.92；95%CI，0.88-0.97）。竞争风险分析也得出了类似的结果。死亡率的独立预测因素包括年龄、终末期肝病模型评分、血清白蛋白水平、腹水、肝性脑病、糖尿病、丙型肝炎病毒感染和低体重指数（<24.4kg/m2）。
在肝移植等待名单上的肝硬化患者中，患有 PVT 的患者死亡率低于无 PVT 的患者。
