Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation

Background and aims: Splanchnic vein thrombosis is a significant source of complications in candidates for liver transplantation. The aims of this study were: (a) to determine the prevalence of and risk factors for splanchnic vein thrombosis in cirrhotic patients awaiting transplantation and (b) to...

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Bibliographic Details
Published in:Gut 2005-05, Vol.54 (5), p.691-697
Main Authors: Francoz, C, Belghiti, J, Vilgrain, V, Sommacale, D, Paradis, V, Condat, B, Denninger, M H, Sauvanet, A, Valla, D, Durand, F
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anticoagulants - therapeutic use
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
cirrhosis
computed tomography
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Doppler ultrasonography
Doppler-US
Female
Gastroenterology. Liver. Pancreas. Abdomen
HBV
HCC
HCV
hepatitis B virus
hepatitis C virus
hepatocellular carcinoma
Humans
INR
international normalised ratio
Liver
Liver cirrhosis
Liver Cirrhosis - complications
Liver Cirrhosis - surgery
Liver Transplantation
Liver, biliary tract, pancreas, portal circulation, spleen
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Magnetic Resonance Imaging
Male
Mass Screening - methods
Medical imaging
Medical sciences
Middle Aged
Mortality
MRI
Other diseases. Semiology
portal hypertension
portal vein thrombosis
Preoperative Care - methods
Risk Factors
Splanchnic Circulation
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival Analysis
Treatment Outcome
Ultrasonography, Doppler
Veins & arteries
Venous Thrombosis - diagnosis
Venous Thrombosis - drug therapy
Venous Thrombosis - etiology
vitamin K antagonists
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Summary:Background and aims: Splanchnic vein thrombosis is a significant source of complications in candidates for liver transplantation. The aims of this study were: (a) to determine the prevalence of and risk factors for splanchnic vein thrombosis in cirrhotic patients awaiting transplantation and (b) to assess the usefulness of anticoagulation. Methods: A total of 251 cirrhotic patients listed for transplantation were analysed. All underwent systematic screening for thrombosis with Doppler ultrasonography. During the second period of the study, all patients with thrombosis received anticoagulation up to transplantation while during the first period none had received anticoagulation. Results: The incidence of splanchnic vein thrombosis at evaluation was 8.4%. Seventeen additional patients (7.4%) developed de novo thrombosis after evaluation. Independent risk factors for thrombosis were low platelet count (77.4 (36.3) v 111.6 (69.2) 109/l; p = 0.001), a past history of variceal bleeding (47.4% v 29.1%; p = 0.003), and a prolonged interval from listing to transplantation (8.5 (6.8) v 4.8 (4.4) months; p = 0.002). The proportion of partial or complete recanalisation was significantly higher in those who received (8/19) than in those who did not receive (0/10, p = 0.002) anticoagulation. Survival was significantly lower in those who had complete portal vein thrombosis at the time of surgery (p = 0.04). Conclusion: These results support a systematic screening for splanchnic vein thrombosis in patients awaiting transplantation. They suggest that in these patients, anticoagulation is safe and has a significant impact on recanalisation as well as prevention of extension of thrombosis.
ISSN:0017-5749
1468-3288
1458-3288
DOI:10.1136/gut.2004.042796