Portal vein surgical treatment on non-tumoral portal vein thrombosis in liver transplantation: Systematic Review and Meta-Analysis

Authors

  • Lucas S. Nacif Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia
  • Leonardo Y. Zanini Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia
  • Rafael S. Pinheiro Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia
  • Daniel R. Waisberg Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia
  • Vinicius Rocha-Santos Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia
  • Wellington Andraus Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia
  • Flair J. Carrilho Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia
  • Luiz Carneiro-D’Albuquerque Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Departamento de Gastroenterologia

DOI:

https://doi.org/10.6061/clinics/2021/e2184

Keywords:

Liver Transplantation, Portal Vein Thrombosis, Systematic Review, Portal Vein, Cirrhotic, Liver Disease

Abstract

Non-tumoral portal vein thrombosis (PVT) is associated with higher morbidity and mortality in liver transplantation (LT). In this study, we aimed to evaluate the impact of PVT in LT outcomes and analyze the types of surgical techniques used for dealing with PVT during LT. A systematic review was conducted in Cochrane, MEDLINE, and EMBASE databases, selecting articles from January 1990 to December 2019. The MESH-terms used were (‘‘Portal Vein’’[Mesh] AND ‘‘Thrombosis’’[Mesh] NOT ‘‘Neoplasms’’[Mesh]) AND (‘‘Liver Transplantation’’[Mesh]). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendation was used, and meta-analysis was performed with Review Manager Version 5.3 software. A total of 1,638 articles were initially found: 488 in PubMed, 289 in Cochrane Library, and 861 in EMBASE, from which 27 were eventually selected for the meta-analysis. Surgery time of LT in patients with PVT was longer than in patients without LT (po0.0001). Intraoperative red blood cell (po0.00001), fresh frozen plasma (p=0.01), and platelets (p=0.03) transfusions during LT were higher in patients with PVT. One-year (odds ratio [OR] 1.17; p=0.002) and 5-year (OR 1.12; p=0.01) patient survival after LT was worse in the PVT group. Total occlusive PVT presented higher mortality (OR 3.70; p=0.00009) and rethrombosis rates (OR 3.47 [1.18–10.21]; p=0.02). PVT Yerdel III/IV classification exhibited worse 1-year [2.04 (1.21–3.42); p=0.007] and 5-year [0.98 (0.59–1.62); p=0.93] patient survival. Thrombectomy with primary anastomosis was associated with better outcomes. LT in patients with non-tumoral PVT demands more surgical time, needs more intraoperative transfusion, and presents worse 1- and 5-year patient survival. Total occlusive PVT and Yerdel III/IV PVT classification were associated with higher mortality. (PROSPERO, registration number: CRD42020132915).

Downloads

Download data is not yet available.

Downloads

Published

2021-11-09

Issue

Section

Review Articles

How to Cite

Portal vein surgical treatment on non-tumoral portal vein thrombosis in liver transplantation: Systematic Review and Meta-Analysis. (2021). Clinics, 76, e2184. https://doi.org/10.6061/clinics/2021/e2184