The Management of Portal Vein Thrombosis after Adult Liver Transplantation: A Case Series and Review of the Literature

Abstract

Background: Portal vein thrombosis (PVT) after adult liver transplantation (LT) is a rare but serious complication with no consensus on the ideal treatment. We report a case series and a comprehensive review of the literature on PVT after LT to discuss the therapeutic options.

Methods: The clinical data of 360 adult patients (≥18 years of age) who underwent LT from January 2017 to January 2020 were reviewed, and a comprehensive search of PubMed and Web of Science was conducted. Patients diagnosed with PVT after LT were identified, and relevant risk factors and therapies were analyzed.

Results: Among the 360 patients, 7 (1.94%) developed PVT after LT. Onset of PVT within one week after LT was found in six patients (85.71%). Four of the seven patients with PVT received systemic anticoagulation (low molecular weight heparin and warfarin) therapy. Minimally invasive interventional therapies combined with systemic anticoagulation (heparin and warfarin) were applied for three patients, two of whom died because of severe abdominal hemorrhage and liver failure. Of the 33 cases reported in the literature, minimally invasive interventional therapy combined with systematic anticoagulation or sclerotherapy were the most-used methods (20/33). Systemic anticoagulation was administered to four patients, and surgical operation (thrombectomy; portosystemic shunt and retransplantation) was performed for nine patients. Among these 33 patients, 4 eventually died.

Conclusions: Interventional therapy combined with systemic anticoagulation is a good choice for the management of PVT after LT, and in our experience, systemic anticoagulation alone can also have a positive effect for early PVT patients.

Keywords: case series; liver transplantation; portal vein thrombosis.

Figure 1

Symptoms present in patients with portal vein thrombosis after liver transplantation. For the 33 patients with portal vein thrombosis after liver transplantation reviewed in the literature, most-to-least common symptoms were derangement of liver function (15/33, 45.5%), ascites (9/33, 27.3%), abdominal pain (7/33, 21.2%), hepatic encephalopathy (5/33, 15.2%), gastrointestinal tract bleeding (4/33, 12.1%), fever (4/33, 12.1%), and jaundice (3/33, 9.15); however, 6 patients (6/33, 18.2%) were asymptomatic.