Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena.
Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova.
Int J Surg. 2024 May 1;110(5):2874-2882. doi: 10.1097/JS9.0000000000001149.
Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients.
Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant.
Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT ( P <0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present.
Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3-4.
除了围手术期发病率、移植物失功和死亡率增加之外，大多数门静脉血栓形成（PVT）是在肝移植（LT）时诊断的。改善术前管理和患者选择可能会导致更好的短期和长期结果，并降低LT 无效的风险。作者旨在通过分析意大利 LT 受者队列的结果，确定非恶性门静脉血栓形成（PVT）患者 LT 后不良结局的预测因素，并通过分析意大利 LT 受者队列的结果来改善供体与受者的匹配。
本研究纳入了 2000 年 1 月至 2020 年 2 月期间在意大利接受 LT 的成年患者，这些患者在 LT 前或 LT 时被诊断为 PVT。根据涵盖所有参与研究的 26 位外科医生的调查，定义了一个二元复合结局。如果至少发生以下一种情况，患者被归类为发生复合事件：手术时间超过 600 分钟、估计出血量超过 5000ml、超过 20 天 ICU 住院、90 天死亡率、90 天再次移植。
对 714 名患者进行了筛选，698 名符合纳入标准。分析报告了符合复合结局分析标准的 568 名患者的结果。总体而言，156 名患者（27.5%）发生了复合结局。移植时 PVT 分期 3/4 和需要任何 PVT 手术矫正均是复合结局发生的独立预测因素。按 PVT 分级分层，1 年总生存率从 PVT 0/1 级的 89.0%到 LT 时 PVT 3/4 级的 67.4%（P<0.001）。然而，当不存在特定的危险因素时，患有严重 PVT 的患者可以改善其生存率。
受 PVT 影响的潜在 LT 候选者从 LT 中获益，但应根据肝功能和所需的流入道重建类型进行充分平衡，以减轻不良事件的发生率。尽管如此，即使在 PVT 3-4 级的患者中，不存在特定的危险因素也可能改善结局。
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