高达 50%的门静脉血栓形成在肝移植前未被诊断。

Up to 50% of portal vein thrombosis remains undiagnosed until liver transplantation.

机构信息

Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.

General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium.

出版信息

Clin Transplant. 2020 Dec;34(12):e14107. doi: 10.1111/ctr.14107. Epub 2020 Oct 27.

DOI:10.1111/ctr.14107

PMID:33030231

Abstract

BACKGROUND

Impact of portal vein thrombosis (PVT) on the clinical course in liver transplant candidates remains unclear. This study aims to identify prevalence and risk factors for PVT, assess outcome after liver transplantation (LT) in patients with PVT and study the effect of anticoagulation.

METHODS

This single-center retrospective cohort study was performed from January 2006 until June 2016. Patients were stratified according to presence of PVT. Risk factors and outcome were assessed using logistic regression and survival analysis.

RESULTS

Among 390 adults who underwent orthotopic LT, PVT occurred in 40 (10.3%). In, respectively, 10 (25%), 7 (17.5%), and 23 (57.5%) patients, PVT was identified at time of evaluation for transplantation, on the waiting list and during transplantation. A beneficial trend was present favoring the use of anticoagulation for PVT resolution (n = 3/7 vs 0/9; p = .062). Patient and graft survival were similar between the groups after a median follow-up of 5 years. However, 1-year patient survival was significantly lower (p = .031) in patients with PVT.

CONCLUSION

Portal vein thrombosis occurred in 10% of patients awaiting LT was undiagnosed in 50% until moment of LT and had a deleterious effect on 1-year survival. Anticoagulation showed a beneficial trend on recanalization of PVT and survival rate.

摘要

背景

门静脉血栓形成（PVT）对肝移植候选者的临床病程的影响尚不清楚。本研究旨在确定 PVT 的患病率和危险因素，评估 PVT 患者肝移植（LT）后的结局，并研究抗凝的效果。

方法

这是一项单中心回顾性队列研究，于 2006 年 1 月至 2016 年 6 月进行。根据是否存在 PVT 将患者分层。使用逻辑回归和生存分析评估风险因素和结局。

结果

在 390 例接受原位 LT 的成年人中，40 例（10.3%）发生 PVT。分别在 10 例（25%）、7 例（17.5%）和 23 例（57.5%）患者中，在移植评估时、在等待名单上和在移植期间发现 PVT。存在使用抗凝治疗使 PVT 消退的有益趋势（n=3/7 比 0/9；p=0.062）。中位随访 5 年后，两组患者的患者和移植物存活率相似。然而，PVT 患者的 1 年患者生存率显著降低（p=0.031）。