Portal Vein Thrombosis in Patients with End Stage Liver Disease Awaiting Liver Transplantation: Outcome of Anticoagulation

Portal vein thrombosis, which is present in up to one quarter of patients with end-stage liver disease, presents a technical challenge at the time of liver transplantation. Thromboendovenectomy when feasible has been advocated in these patients. However, in patients with complete mesenteric thrombosis where this technique is typically not successful, a number of alternative techniques have been attempted including caval transposition, portal arterialization, and multi-visceral transplantation often with discouraging results. We present herein a single case where transplant renal vein outflow was used to provide portal vein inflow in a patient with complete mesenteric thrombosis undergoing simultaneous liver-kidney transplant.

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LDLT Portal Vein Thrombosis: Technical Advances

QJM ◽

10.1093/qjmed/hcaa050.043 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M B Ahmed ◽

M A Rady ◽

M A Abd-errazik ◽

A R M A Azzam

Keyword(s):

Liver Transplantation ◽

Blood Loss ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Operative Time ◽

Surgical Techniques ◽

Vein Thrombosis ◽

Operative Complications ◽

End Stage ◽

Post Operative Complications

Abstract Background portal vein thrombosis (PVT) is a common complication of end-stage liver disease with an incidence of 0.6–16% in patients with well-compensated disease (1–3), increasing up to 35% in cirrhotic patients with hepatocellular carcinoma. Aim of the Work the aim of the study is to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis, and post-operative complications. Patients and Methods This is a retrospective cohort study to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis & post-operative complications. The study was conducted as retrospective study of 33 adult patients who underwent LDLT at Ain Shams Specialized Hospital, Ain Shams University, Cairo, Egypt, between January 2016 and July 2018. Results the mean child score was 9.55 and the median hospital stay was 12 days. Based on review manager statics program, the PVT recurrence was non-significant (P = 0.295, Test value: 1.096). However, the blood loss was significant (p < 0.029, test value: -2.186) and the surgical time was significant (p = 0.013, test value: 2.633). Conclusion portal vein thrombosis (PVT) represents a significant technical challenge in liver transplantation and for many years was considered a relative contraindication. While advances in surgical techniques, axial imaging, and alternative inflow reconstruction options have made liver transplantation possible in transplant candidates with PVT.

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Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00344-6 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Ahmed Abdelrahman Mohamed Baz ◽

Rana Magdy Mohamed ◽

Khaled Helmy El-kaffas

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Portal Vein ◽

Hepatic Artery ◽

Meld Score ◽

Hepatic Decompensation ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

Us Findings ◽

End Stage

Abstract Background Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly. Results By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV). There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266). Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate. Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated. Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity. Conclusion Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

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Multicentric evaluation of model for end-stage liver disease-based allocation and survival after liver transplantation in Germany - limitations of the ‘sickest first’-concept

Transplant International ◽

10.1111/j.1432-2277.2010.01161.x ◽

2010 ◽

Vol 24 (1) ◽

pp. 91-99 ◽

Cited By ~ 108

Author(s):

Tobias J. Weismüller ◽

Panagiotis Fikatas ◽

Jan Schmidt ◽

Ana P. Barreiros ◽

Gerd Otto ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

End Stage Liver Disease ◽

End Stage

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Low psoas muscle index as an unfavorable factor in children with end‐stage liver disease undergoing liver transplantation

Pediatric Transplantation ◽

10.1111/petr.13996 ◽

2021 ◽

Author(s):

Settapong Jitwongwai ◽

Chatmanee Lertudomphonwanit ◽

Thitiporn Junhasavasdikul ◽

Praman Fuangfa ◽

Pornthep Tanpowpong ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Psoas Muscle ◽

End Stage Liver Disease ◽

End Stage

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RIPK3-Mediated Necroptosis and Neutrophil Infiltration Are Associated with Poor Prognosis in Patients with Alcoholic Cirrhosis

Journal of Immunology Research ◽

10.1155/2018/1509851 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Zhenzhen Zhang ◽

Guomin Xie ◽

Li Liang ◽

Hui Liu ◽

Jing Pan ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Poor Prognosis ◽

Alcoholic Cirrhosis ◽

Normal Liver ◽

Neutrophil Infiltration ◽

Meld Score ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

End Stage

Alcoholic cirrhosis is an end-stage liver disease with impaired survival and often requires liver transplantation. Recent data suggests that receptor-interacting protein kinase-3- (RIPK3-) mediated necroptosis plays an important role in alcoholic cirrhosis. Additionally, neutrophil infiltration is the most characteristic pathologic hallmark of alcoholic hepatitis. Whether RIPK3 level is correlated with neutrophil infiltration or poor prognosis in alcoholic cirrhotic patients is still unknown. We aimed to determine the correlation of RIPK3 and neutrophil infiltration with the prognosis in the end-stage alcoholic cirrhotic patients. A total of 20 alcoholic cirrhotic patients subjected to liver transplantation and 5 normal liver samples from control patients were retrospectively enrolled in this study. Neutrophil infiltration and necroptosis were assessed by immunohistochemical staining for myeloperoxidase (MPO) and RIPK3, respectively. The noninvasive score system (model for end-stage liver disease (MELD)) and histological score systems (Ishak, Knodell, and ALD grading and ALD stage) were used to evaluate the prognosis. Neutrophil infiltration was aggravated in patients with a high MELD score (≥32) in the liver. The MPO and RIPK3 levels in the liver were positively related to the Ishak score. The RIPK3 was also significantly and positively related to the Knodell score. In conclusion, RIPK3-mediated necroptosis and neutrophil-mediated alcoholic liver inflammatory response are highly correlated with poor prognosis in patients with end-stage alcoholic cirrhosis. RIPK3 and MPO might serve as potential predictors for poor prognosis in alcoholic cirrhotic patients.

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