Translational gastroenterology and hepatology · 2026
Preoperative portal vein thrombosis did not compromise long-term survival after liver transplantation with proper portal inflow reconstruction.
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Cai Ru-Zhou, Huang Yong-Fa, Qu Wei, Wei Lin, Zhang Hai-Ming, Zeng Zhi-Gui, Sun Li-Ying, Zhu Zhi-Jun
Аннотация
BACKGROUND: Portal vein thrombosis (PVT) increases operative complexity and complication risks in liver transplantation (LT), but whether it compromises long-term survival with proper portal inflow reconstruction remains debated. This study aimed to evaluate the impact of preoperative PVT on perioperative and long-term outcomes after LT and to assess outcomes following individualized portal inflow reconstruction in patients with complex PVT.
METHODS: Adult orthotopic LT recipients between 2016 and 2024 were retrospectively recruited and stratified into PVT (n=144) and non-PVT (n=373) groups. Baseline, operative, and survival data were compared.
RESULTS: PVT patients had higher rates of Child-Pugh B/C (86.2% vs. 74.8%), hepatic encephalopathy (30.6% vs. 20.6%), upper gastrointestinal bleeding (UGIB; 57.6% vs. 35.9%), and prior splenectomy (16.7% vs. 2.4%; all P<0.05). Independent predictors of PVT included older age [odds ratio (OR) 1.03; 95% confidence interval (CI), 1.01-1.05; P=0.008], hepatitis B virus (HBV)-related cirrhosis (OR 2.12; 95% CI, 1.19-3.77; P=0.01) and prior splenectomy (OR 6.72; 95% CI, 2.85-15.85; P<0.001). PVT was associated with more deceased donor grafts (86.8% vs. 75.1%), longer operative time (453 vs. 405 min), greater blood loss (1,200 vs. 800 mL), and more red blood cell transfusions (800 vs. 600 mL; all P<0.01). Among 12 PVT patients undergoing non-anatomical reconstruction, 4 (33.3%) developed vascular complications. PV-related complications (16.2% vs. 3.5%) and 1-year renal dysfunction (52.5% vs. 39.4%) were more frequent in the PVT group (P<0.05). However, preoperative PVT was not an independent predictor of long-term survival in Kaplan-Meier or Cox regression.
CONCLUSIONS: Preoperative PVT did not compromise long-term survival after LT but increased operative complexity, PV-related complications, and renal dysfunction. When appropriately designed, a non-anatomical portal reconstruction strategy could achieve favorable outcomes in complex PVT cases.
METHODS: Adult orthotopic LT recipients between 2016 and 2024 were retrospectively recruited and stratified into PVT (n=144) and non-PVT (n=373) groups. Baseline, operative, and survival data were compared.
RESULTS: PVT patients had higher rates of Child-Pugh B/C (86.2% vs. 74.8%), hepatic encephalopathy (30.6% vs. 20.6%), upper gastrointestinal bleeding (UGIB; 57.6% vs. 35.9%), and prior splenectomy (16.7% vs. 2.4%; all P<0.05). Independent predictors of PVT included older age [odds ratio (OR) 1.03; 95% confidence interval (CI), 1.01-1.05; P=0.008], hepatitis B virus (HBV)-related cirrhosis (OR 2.12; 95% CI, 1.19-3.77; P=0.01) and prior splenectomy (OR 6.72; 95% CI, 2.85-15.85; P<0.001). PVT was associated with more deceased donor grafts (86.8% vs. 75.1%), longer operative time (453 vs. 405 min), greater blood loss (1,200 vs. 800 mL), and more red blood cell transfusions (800 vs. 600 mL; all P<0.01). Among 12 PVT patients undergoing non-anatomical reconstruction, 4 (33.3%) developed vascular complications. PV-related complications (16.2% vs. 3.5%) and 1-year renal dysfunction (52.5% vs. 39.4%) were more frequent in the PVT group (P<0.05). However, preoperative PVT was not an independent predictor of long-term survival in Kaplan-Meier or Cox regression.
CONCLUSIONS: Preoperative PVT did not compromise long-term survival after LT but increased operative complexity, PV-related complications, and renal dysfunction. When appropriately designed, a non-anatomical portal reconstruction strategy could achieve favorable outcomes in complex PVT cases.