Hu Liang-Shuo, Zhao Zhen, Li Tao, Li Qin-Shan, Lu Yi, Wang Bo
Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an 710061, China.
J Clin Med. 2022 Aug 21;11(16):4909. doi: 10.3390/jcm11164909.
Portal vein thrombosis (PVT) after adult liver transplantation (LT) is a rare but serious complication with no consensus on the ideal treatment. We report a case series and a comprehensive review of the literature on PVT after LT to discuss the therapeutic options.
The clinical data of 360 adult patients (≥18 years of age) who underwent LT from January 2017 to January 2020 were reviewed, and a comprehensive search of PubMed and Web of Science was conducted. Patients diagnosed with PVT after LT were identified, and relevant risk factors and therapies were analyzed.
Among the 360 patients, 7 (1.94%) developed PVT after LT. Onset of PVT within one week after LT was found in six patients (85.71%). Four of the seven patients with PVT received systemic anticoagulation (low molecular weight heparin and warfarin) therapy. Minimally invasive interventional therapies combined with systemic anticoagulation (heparin and warfarin) were applied for three patients, two of whom died because of severe abdominal hemorrhage and liver failure. Of the 33 cases reported in the literature, minimally invasive interventional therapy combined with systematic anticoagulation or sclerotherapy were the most-used methods (20/33). Systemic anticoagulation was administered to four patients, and surgical operation (thrombectomy; portosystemic shunt and retransplantation) was performed for nine patients. Among these 33 patients, 4 eventually died.
Interventional therapy combined with systemic anticoagulation is a good choice for the management of PVT after LT, and in our experience, systemic anticoagulation alone can also have a positive effect for early PVT patients.
成人肝移植（LT）后门静脉血栓形成（PVT）是一种罕见但严重的并发症，对于理想的治疗方法尚无共识。我们报告了一组病例系列，并对LT后PVT的文献进行了全面综述，以讨论治疗选择。
回顾了2017年1月至2020年1月接受LT的360例成年患者（≥18岁）的临床资料，并对PubMed和科学网进行了全面检索。确定LT后被诊断为PVT的患者，并分析相关危险因素和治疗方法。
在360例患者中，7例（1.94%）在LT后发生PVT。6例患者（85.71%）在LT后一周内发生PVT。7例PVT患者中有4例接受了全身抗凝（低分子量肝素和华法林）治疗。3例患者采用了微创介入治疗联合全身抗凝（肝素和华法林），其中2例因严重腹腔出血和肝衰竭死亡。在文献报道的33例病例中，微创介入治疗联合全身抗凝或硬化治疗是最常用的方法（20/33）。4例患者接受了全身抗凝治疗，9例患者进行了手术（血栓切除术；门体分流术和再次移植）。在这33例患者中，4例最终死亡。
介入治疗联合全身抗凝是LT后PVT管理的一个不错选择，根据我们的经验，单独全身抗凝对早期PVT患者也可产生积极效果。
