title: Advanced non-alcoholic steatohepatitis cirrhosis: A high-risk population for pre-liver transplant portal vein thrombosis.
abstract: OBJECTIVE
  To examine if liver transplant recipients with high-risk non-alcoholic steatohepatitis (NASH) are at increased risk for pre-transplant portal venous thrombosis.
  
  
  METHODS
  Data on all liver transplants in the United States from February 2002 through September 2014 were analyzed. Recipients were sorted into three distinct groups: High-risk (age > 60, body mass index > 30 kg/m2, hypertension and diabetes), low-risk and non-NASH cirrhosis. Multivariable logistic regression models were constructed.
  
  
  RESULTS
  Thirty-five thousand and seventy-two candidates underwent liver transplantation and of those organ recipients, 465 were transplanted for high-risk and 2775 for low-risk NASH. Two thousand six hundred and twenty-six (7.5%) recipients had pre-transplant portal vein thrombosis; 66 (14.2%) of the high-risk NASH group had portal vein thrombosisvs328 (11.8%) of the low-risk NASH group. In general, all NASH recipients were less likely to be male or African American and more likely to be obese. In adjusted multivariable regression analyses, high-risk recipients had the greatest risk of pre-transplant portal vein thrombosis with OR = 2.11 (95%CI: 1.60-2.76,P< 0.001) when referenced to the non-NASH group.
  
  
  CONCLUSIONS
  Liver transplant candidates with high-risk NASH are at the greatest risk for portal vein thrombosis development prior to transplantation. These candidates may benefit from interventions to decrease their likelihood of clot formation and resultant downstream hepatic decompensating events. Prospective study is needed.
authors.affiliation: Jonathan G Stine, Curtis K Argo, Stephen H Caldwell, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA 22908-0708, United States.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Stine
authors.affiliation: Jonathan G Stine, Curtis K Argo, Stephen H Caldwell, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA 22908-0708, United States.
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.affiliation: Jonathan G Stine, Curtis K Argo, Stephen H Caldwell, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA 22908-0708, United States.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Pelletier
authors.affiliation: Jonathan G Stine, Curtis K Argo, Stephen H Caldwell, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA 22908-0708, United States.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Maluf
authors.affiliation: Jonathan G Stine, Curtis K Argo, Stephen H Caldwell, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA 22908-0708, United States.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Caldwell
authors.affiliation: Jonathan G Stine, Curtis K Argo, Stephen H Caldwell, Patrick G Northup, Division of Gastroenterology and Hepatology, Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, University of Virginia, Charlottesville, VA 22908-0708, United States.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
keywords: Coagulopathy; Hepatology; Liver transplantation; Non-alcoholic fatty liver disease; Portal hypertension