Liver transplantation with portal vein thrombosis – The missing link in optimizing outcome: a case-control study

Background: PVT though no longer contra-indicated for Orthotopic Liver Transplantation (OLT), still associated with increased morbidity and mortality. Aims include outcomes of patients with PVT and also risk factors associated with mortality. Methods: Retrospective case control analysis of primary adult (n=629) patients who underwent OLT between August 2009 – October 2017. Outcomes of PVT were compared to matched non PVT group and analyzed for risk factors for mortality. Results: 69 (10.98%) patients had PVT. Mean age 49.09 ± 9.59 years. Males were 79.7%. 29 patients (42.02%) had Grade I, 30 patients (43.47%) had Grade II, 7 patients (10.14%) Grade III and Grade IV in 3(4.34%). Right lobe graft used in 47, Whole liver 19 and split liver graft in 3. Eversion thrombectomy was done for Grade 1, Combination of Eversion thrombectomy & Interposition Jump Grafts were used in Grade II/III. Cavo-Portal Hemi-transposition was required in 2 & Reno-Portal Transposition was done in 1, Collateral vein as inflow was used in 1. Overall mortality was 8/69 (11.5% Vs 8.69%). Blood loss, operative time, portal pressure, portal flow velocity, Hospital stay were not statistically significant. Risk factors for mortality were previous treatment for PHT like EVL, splenectomy or TIPS (p < 0.00001), CIT (p = 0.002), Sepsis (p < 0.0001), AKI (p < 0.0001) and Early Graft Dysfunction (p = 0.015). Partial PVT occurred in 3 patients (4.34%). Conclusion: Meticulous perioperative management, careful patient selection, and optimal surgical strategies are critical to improve outcomes. Risk factors for mortality are treatment for previous PHT, prolonged CIT, AKI & Sepsis.