Portal vein thrombosis and liver transplantation: management, matching, and outcomes: a retrospective multicenter cohort study.

Journal

International journal of surgery (London, England)
ISSN: 1743-9159
Titre abrégé: Int J Surg
Pays: United States
ID NLM: 101228232

Informations de publication

Date de publication:
04 Mar 2024
Historique:
received: 22 12 2023
accepted: 26 01 2024
medline: 6 3 2024
pubmed: 6 3 2024
entrez: 6 3 2024
Statut: aheadofprint

Résumé

Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients. Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant. Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT (P<0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present. Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3-4.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients.
METHODS METHODS
Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant.
RESULTS RESULTS
Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT (P<0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present.
CONCLUSIONS CONCLUSIONS
Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3-4.

Identifiants

DOI: 10.1097/JS9.0000000000001149 PMID: 38445440
pubmed: 38445440
doi: 10.1097/JS9.0000000000001149
pii: 01279778-990000000-01120
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

Auteurs

Fabrizio Di Benedetto (F)

Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena.

Paolo Magistri (P)

Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena.

Stefano Di Sandro (S)

Hepato-pancreato-biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena.

Riccardo Boetto (R)

Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova.

Francesco Tandoi (F)

Liver Transplant Unit, General Surgery 2U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin.

Stefania Camagni (S)

Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo.

Andrea Lauterio (A)

General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, Milan.
University of Milano-Bicocca.

Duilio Pagano (D)

IRCCS-ISMETT-UPMCI, Palermo.

Daniele Nicolini (D)

Hepatobiliary, Pancreatic and Transplantation Surgery, Dept. of Experimental and Clinical Medicine, Polytechnic University of Marche.

Paola Violi (P)

Department of General Surgery and Dentistry, Liver Transplant Unit, University Hospital of Verona, Verona.

Daniele Dondossola (D)

Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi, Milan.

Nicola Guglielmo (N)

Department of General Surgery and Transplantation, San Camillo-Forlanini General Hospital, Rome.

Vittorio Cherchi (V)

Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, Udine.

Quirino Lai (Q)

Department of General Surgery and Organ Transplantation, Sapienza University.

Luca Toti (L)

Department of Surgery Science, Transplant and HPB Unit, University of Rome Tor Vergata, Rome.

Marco Bongini (M)

Department of Oncology and Hemato-Oncology, University of MilanHepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano.

Samuele Frassoni (S)

Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan.

Vincenzo Bagnardi (V)

Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan.

Vincenzo Mazzaferro (V)

Department of Oncology and Hemato-Oncology, University of MilanHepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano.

Giuseppe Tisone (G)

Department of Surgery Science, Transplant and HPB Unit, University of Rome Tor Vergata, Rome.

Massimo Rossi (M)

Department of General Surgery and Organ Transplantation, Sapienza University.

Umberto Baccarani (U)

Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, Udine.

Giuseppe Maria Ettorre (GM)

Department of General Surgery and Transplantation, San Camillo-Forlanini General Hospital, Rome.

Lucio Caccamo (L)

Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi, Milan.

Amedeo Carraro (A)

Department of General Surgery and Dentistry, Liver Transplant Unit, University Hospital of Verona, Verona.

Marco Vivarelli (M)

Hepatobiliary, Pancreatic and Transplantation Surgery, Dept. of Experimental and Clinical Medicine, Polytechnic University of Marche.

Salvatore Gruttadauria (S)

IRCCS-ISMETT-UPMCI, Palermo.
Hepatobiliary, Pancreatic and Transplantation Surgery, Dept. of Experimental and Clinical Medicine, Polytechnic University of Marche.
Department of General Surgery and Dentistry, Liver Transplant Unit, University Hospital of Verona, Verona.
Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi, Milan.
Department of General Surgery and Transplantation, San Camillo-Forlanini General Hospital, Rome.
Liver-Kidney Transplant Unit, Department of Medicine, University of Udine, Udine.
Department of General Surgery and Organ Transplantation, Sapienza University.
Department of Surgery Science, Transplant and HPB Unit, University of Rome Tor Vergata, Rome.
Department of Oncology and Hemato-Oncology, University of MilanHepatology and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano.
Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan.
University of Catania, Catania, Italy.

Luciano De Carlis (L)

General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, Milan.
University of Milano-Bicocca.

Michele Colledan (M)

Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo.
General Surgery and Abdominal Transplantation Unit, Niguarda-Cà Granda Hospital, Milan.
University of Milano-Bicocca.

Renato Romagnoli (R)

Liver Transplant Unit, General Surgery 2U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin.

Umberto Cillo (U)

Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova.

Classifications MeSH