Cheloff Abraham Z, Bonanni Luke J, Kirschenbaum Joshua D, Luke Naveena, Engelman Jenny L, Ross Joshua L, Fuligni Gabriel, Northup Patrick G
Department of Medicine, NYU Langone Health, New York, NY, USA.
NYU Grossman School of Medicine, New York, NY, USA.
Hepatol Int. 2025 Feb;19(1):191-198. doi: 10.1007/s12072-024-10734-x. Epub 2024 Oct 1.
Portal vein thrombosis (PVT) is associated with increased mortality post-transplant, but treatment of the clot is not definitively associated with improvement in mortality. We aimed to assess the effect of anticoagulation (AC), transjugular intrahepatic portosystemic shunt (TIPS), or best supportive care only (SCO) as treatment options in patients with PVT and cirrhosis.
This was a retrospective controlled cohort study from a large urban health system. Patients with cirrhosis and PVT were identified and analyzed based on treatment provided (1) AC, (2) TIPS, and (3) SCO. Outcomes included patent portal vein at the end of follow-up and overall mortality.
150 patients on AC, 93 who underwent TIPS, and 172 who received SCO were analyzed. Final portal vein (PV) patency was not significantly different by treatment group in those with partial obstruction at presentation (p = 0.64), while any treatment improved final patency over SCO in those presenting with complete obstruction (p = 0.01). Rate of survival, transplant-free survival, and successful liver transplantation were not different between treatment groups.
In our cohorts, treatment of PVT versus SCO showed no impact on survival in those presenting with partial obstruction of the PV. In those with complete obstruction, any treatment was more effective than SCO in achieving patency of the PV, but overall survival was no different. PVT may not be a pathologic mechanism that causes worsening of liver disease but may be an event in the progression that in itself is not directly responsible for worsening liver function.
门静脉血栓形成（PVT）与移植后死亡率升高相关，但血栓治疗与死亡率改善并无明确关联。我们旨在评估抗凝治疗（AC）、经颈静脉肝内门体分流术（TIPS）或仅采用最佳支持治疗（SCO）作为PVT合并肝硬化患者的治疗方案的效果。
这是一项来自大型城市卫生系统的回顾性对照队列研究。根据所提供的治疗方法（1）AC、（2）TIPS和（3）SCO对肝硬化合并PVT患者进行识别和分析。结局包括随访结束时门静脉通畅及总体死亡率。
分析了150例接受AC治疗的患者、93例接受TIPS治疗的患者和172例接受SCO治疗的患者。在就诊时存在部分梗阻的患者中，各治疗组的最终门静脉（PV）通畅率无显著差异（p = 0.64），而在就诊时存在完全梗阻的患者中，任何治疗方法的最终通畅率均优于SCO（p = 0.01）。各治疗组之间的生存率、无移植生存率和成功肝移植率无差异。
在我们的队列中，PVT患者与接受SCO治疗的患者相比，对于PV部分梗阻的患者，治疗对生存无影响。对于完全梗阻的患者，任何治疗在实现PV通畅方面均比SCO更有效，但总体生存率无差异。PVT可能不是导致肝病恶化的病理机制，而可能是疾病进展过程中的一个事件，其本身并不直接导致肝功能恶化。
