title: Liver transplant recipients with portal vein thrombosis receiving an organ from a high-risk donor are at an increased risk for graft loss due to hepatic artery thrombosis.
abstract: We hypothesize that recipients with pretransplant portal vein thrombosis (PVT) receiving organs from high-risk donors (HRD) are at an increased risk of HAT. Data on all liver transplants in the United States from February 2002 to March 2015 were analyzed. Recipients were sorted into two groups: those with PVT and those without. HRDs were defined by donor risk index (DRI) >1.7. Multivariable logistic regression models were constructed to assess the independent risk factors for HAT with the resultant graft loss ≤90 days from transplantation. A total of 60 404 candidates underwent liver transplantation; of those recipients, 623 (1.0%) had HAT, of which 66.0% (n = 411) received organs from HRDs compared with 49.3% (n = 29 473) in recipients without HAT (P < 0.001); 2250 (3.7%) recipients had pretransplantation PVT and received organs from HRDs. On adjusted multivariable analysis, PVT with a HRD organ was the most significant independent risk factor (OR 3.56, 95% CI 2.52-5.02, P < 0.001) for the development of HAT. Candidates with pretransplant PVT who receive an organ from a HRD are at the highest risk for postoperative HAT independent of other measurable factors. Recipients with pretransplant PVT would benefit from careful donor selection and possibly anticoagulation perioperatively.
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA, USA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Stine
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA, USA.
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.affiliation: Division of Transplant, Department of Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Pelletier
authors.affiliation: Division of Transplant, Department of Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Maluf
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA, USA.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D003625:Data Collection; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein / Q000473:pathology*; D012044:Regression Analysis; D012307:Risk Factors; D014019:Tissue Donors; D014481:United States; D020246:Venous Thrombosis / Q000150:complications*
chemical_list: D000925:Anticoagulants
keywords: cirrhosis; coagulopathy; hepatology; outcomes; portal hypertension