Sanchez-Ocaña R, Tejedor-Tejada J, Cimavilla-Roman M, de Benito-Sanz M, Asensio-Diaz E, Barrera-Rebollo A, Perez-Saborido B, Garcia-Pajares F, Almohalla-Alvarez C, Sanchez-Antolin G
Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain.
Liver Transplant Unit, Hepatology and Gastroenterology Department, Rio Hortega University Hospital, Valladolid, Spain.
Transplant Proc. 2019 Jan-Feb;51(1):83-86. doi: 10.1016/j.transproceed.2018.07.014. Epub 2018 Jul 10.
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.
The aim of our study was to determine the efficacy of oral anticoagulants (OAC) as prophylaxis for recurrent PVT after liver transplantation.
Our study included 215 liver transplant patients who underwent surgery in our center from January 2012 to August 2017. We selected all patients diagnosed with PVT either pre-transplantation (using Doppler echography or Angio-CT) or during transplant surgery. All patients with PVT were initially anticoagulated with low-molecular-weight heparin in the postoperative period; at discharge they received OAC for a duration of six months. Control Doppler ultrasound was performed at 3, 6, and 12 months post-transplantation.
PVT was identified in 37 out of 215 patients (17.2%). PVT was diagnosed with a pre-transplant vascular study in 17 out of 37 cases (45.9%). All patients were anticoagulated with OAC (warfarin) for at least 6 months. There were no cases of recurrent thrombosis and no complications associated with anticoagulant treatment throughout the follow-up period.
The prevalence of portal thrombosis in liver transplant patients in our study was fairly high, at 17.2%. PVT was identified in nearly 50% of patients using high-quality vascular studies prior to transplant surgery. Anticoagulation with OAC for 6 months was effective in preventing a recurrence of thrombosis and there were no associated complications.
门静脉血栓形成（PVT）在肝移植患者中是一种相对常见的情况。尽管预防其复发的建议是进行3至6个月的抗凝治疗，但这存在争议。
我们研究的目的是确定口服抗凝剂（OAC）作为肝移植后复发性PVT预防措施的疗效。
我们的研究纳入了2012年1月至2017年8月在我们中心接受手术的215例肝移植患者。我们选择了所有在移植前（使用多普勒超声或血管造影CT）或移植手术期间被诊断为PVT的患者。所有PVT患者术后初期均用低分子肝素进行抗凝治疗；出院时他们接受OAC治疗6个月。在移植后3、6和12个月进行对照多普勒超声检查。
215例患者中有37例（17.2%）被诊断为PVT。37例病例中有17例（45.9%）通过移植前血管检查确诊为PVT。所有患者均接受OAC（华法林）抗凝治疗至少6个月。在整个随访期间，没有复发性血栓形成的病例，也没有与抗凝治疗相关的并发症。
在我们的研究中，肝移植患者门静脉血栓形成的患病率相当高，为17.2%。在近50%的患者中，通过移植手术前高质量的血管检查发现了PVT。使用OAC抗凝6个月可有效预防血栓复发，且无相关并发症。
