PDF(Pubmed)
Abstract：
The risk of spontaneous portal vein thrombosis (PVT) is increased in patients on the waiting list for liver transplantation and increases perioperative risks. A predictive PVT risk-index (PVT-RI) calculator has been proposed to determine the risk of incident PVT. We performed a retrospective analysis on adult liver transplant recipients at the NZ Liver Transplant Unit between January 1998 and February 2020. Variables reviewed included age at listing and transplantation, wait time from listing to transplant, indication for listing, gender, ethnicity, etiology of liver disease, listing MELD score, hepatocellular carcinoma (HCC), moderate-to-severe ascites, hepatic encephalopathy (>grade 2), transjugular intrahepatic portosystemic shunt (TIPSS), spontaneous bacterial peritonitis (SBP), and diabetes. Incident PVT was determined by imaging of patients while on the waiting list and assessment at transplantation. A total of 553 out of 706 patients met the inclusion criteria. Of those 553, 18 (3.3%) patients had incident PVT. The PVT-RI calculator was not validated in our cohort with only one of those 18 (6%) patients having a score of >4.6 (high risk cut-off score). Longer waiting time for transplant and listing for liver failure rather than HCC were independent predictors of the risk of incident PVT. There was no statistically significant difference in the incidence of PVT in viral vs. non-viral and cholestatic vs. non-cholestatic etiology of chronic liver disease. Patients with longer waiting times on the transplant waiting list should be monitored regularly for PVT.
摘要：
在等待肝移植的患者中，自发性门静脉血栓形成（PVT）的风险增加，并增加围手术期风险。已提出预测PVT风险指数（PVT-RI）计算器来确定事件PVT的风险。我们在1998年1月至2020年2月之间在新西兰肝脏移植单位对成年肝移植受者进行了回顾性分析。审查的变量包括上市和移植时的年龄，从上市到移植的等待时间，用于列表的指示，性别,种族,肝病的病因，列出MELD分数，肝细胞癌（HCC），中度至重度腹水,肝性脑病（>2级），经颈静脉肝内门体分流术（TIPSS），自发性细菌性腹膜炎（SBP），和糖尿病。通过在等待名单上对患者进行成像并在移植时进行评估来确定发生PVT。706名患者中共有553名符合纳入标准。在这553名患者中，有18名（3.3％）患者发生了PVT。在我们的队列中，PVT-RI计算器未得到验证，只有18名（6％）患者的评分>4.6（高风险截止评分）。等待移植和肝衰竭而不是HCC的时间更长是PVT事件风险的独立预测因素。病毒与病毒的PVT发生率无统计学差异。非病毒性和胆汁淤积慢性肝病的非胆汁淤积性病因。在移植等待名单上等待时间较长的患者应定期监测PVT。
