title: Pre-transplant portal vein thrombosis is an independent risk factor for graft loss due to hepatic artery thrombosis in liver transplant recipients.
abstract: BACKGROUND
  Hepatic artery thrombosis is an uncommon but catastrophic complication following liver transplantation. We hypothesize that recipients with portal vein thrombosis are at increased risk.
  
  
  METHODS
  Data on all liver transplants in the U.S. during the MELD era through September 2014 were obtained from UNOS. Status one, multivisceral, living donor, re-transplants, pediatric recipients and donation after cardiac death were excluded. Logistic regression models were constructed for hepatic artery thrombosis with resultant graft loss within 90 days of transplantation.
  
  
  RESULTS
  63,182 recipients underwent transplantation; 662 (1.1%) recipients had early hepatic artery thrombosis; of those, 91 (13.8%) had pre-transplant portal vein thrombosis, versus 7.5% with portal vein thrombosis but no hepatic artery thrombosis (p < 0.0001). Portal vein thrombosis was associated with an increased independent risk of hepatic artery thrombosis (OR 2.17, 95% CI 1.71-2.76, p < 0.001) as was donor risk index (OR 2.02, 95% CI 1.65-2.48, p < 0.001). Heparin use at cross clamp, INR, and male donors were all significantly associated with lower risk.
  
  
  CONCLUSIONS
  Pre-transplant portal vein thrombosis is associated with post-transplant hepatic artery thrombosis independent of other factors. Recipients with portal vein thrombosis might benefit from aggressive coagulation management and careful donor selection. More research is needed to determine causal mechanism.
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, United States.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Stine
authors.affiliation: Division of Transplant Surgery, Department of Surgery, University of Virginia, United States.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Pelletier
authors.affiliation: Division of Transplant Surgery, Department of Surgery, University of Kansas, United States.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Schmitt
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, United States. Electronic address: northup@virginia.edu.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
mesh_terms: D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011169:Portal Vein / Q000000981:diagnostic imaging; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging