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. 2005 May;54(5):691-7.
doi: 10.1136/gut.2004.042796.

Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation

C Francoz  1 , J Belghiti, V Vilgrain, D Sommacale, V Paradis, B Condat, M H Denninger, A Sauvanet, D Valla, F Durand
Affiliations

Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation

C Francoz et al. Gut. 2005 May.

Abstract

Background and aims: Splanchnic vein thrombosis is a significant source of complications in candidates for liver transplantation. The aims of this study were: (a) to determine the prevalence of and risk factors for splanchnic vein thrombosis in cirrhotic patients awaiting transplantation and (b) to assess the usefulness of anticoagulation.

Methods: A total of 251 cirrhotic patients listed for transplantation were analysed. All underwent systematic screening for thrombosis with Doppler ultrasonography. During the second period of the study, all patients with thrombosis received anticoagulation up to transplantation while during the first period none had received anticoagulation.

Results: The incidence of splanchnic vein thrombosis at evaluation was 8.4%. Seventeen additional patients (7.4%) developed de novo thrombosis after evaluation. Independent risk factors for thrombosis were low platelet count (77.4 (36.3) v 111.6 (69.2) 10(9)/l; p = 0.001), a past history of variceal bleeding (47.4% v 29.1%; p = 0.003), and a prolonged interval from listing to transplantation (8.5 (6.8) v 4.8 (4.4) months; p = 0.002). The proportion of partial or complete recanalisation was significantly higher in those who received (8/19) than in those who did not receive (0/10, p = 0.002) anticoagulation. Survival was significantly lower in those who had complete portal vein thrombosis at the time of surgery (p = 0.04).

Conclusion: These results support a systematic screening for splanchnic vein thrombosis in patients awaiting transplantation. They suggest that in these patients, anticoagulation is safe and has a significant impact on recanalisation as well as prevention of extension of thrombosis.

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Figures

Figure 1
Figure 1
(A, B) Post contrast magnetic resonance imaging showing a partially obstructive thrombus at the junction of the splenic and mesenteric veins (A, white arrow) and complete resolution of the thrombus three months after initiation of anticoagulation (B, white arrow) in a patient with hepatitis C virus related cirrhosis.
Figure 2
Figure 2
Post transplantation survival in patients with patent portal vein or partial portal vein thrombosis who received or did not receive anticoagulation.
Figure 3
Figure 3
Post transplantation survival in patients without portal vein thrombosis or with partial portal vein thrombosis and in those with complete portal vein thrombosis (p = 0.04).
Figure 4
Figure 4
Disposition of the patients in the study population according to the presence or absence of thrombosis and the timing of diagnosis of thrombosis. LT, liver transplantation.
Figure 5
Figure 5
Disposition of the patients with thrombosis according to anticoagulation and response to therapy. LT, liver transplantation.
See this image and copyright information in PMC

References

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