A HIGH-INCIDENCE OF NATIVE PORTAL-VEIN THROMBOSIS IN VETERANS UNDERGOING LIVER-TRANSPLANTATION

The incidence of native portal vein thrombosis (PVT) in liver transpla nt recipients has been reported to range from 2.1 to 13.8%. We have id entified an inordinately high incidence of PVT in a consecutive series of U.S. veterans receiving liver transplants. Between October 1989 an d February 1994, 88 consecutive U.S. veterans received 99 orthotopic l iver transplants under primary Tacrolimus (Prograf, formerly FK506) ba sed immunosuppression. A number of clinical features were examined in an effort to identify risk factors for PVT and outcome was compared to patients without PVT. Native PVT was present in 23/88 (26%) patients. All of these patients were male U.S. veterans with a mean age of 47 y ears. When compared to the 65 patients without PVT, we found no signif icant difference with respect to underlying liver disease, age, Childs -Pugh score (mean = 12), UNOS status as defined prior to April 1995 (9 5% UNOS 3 or 4), previous abdominal surgery, or liver volume. Median b lood loss for patients with PVT (21 units of packed red blood cells) w as greater than for those without PVT (14 units, P = 0.04). Portal thr ombectomy was performed in 11 patients, 11 patients required mesoporta l jump grafts, and 1 patient had an interposition graft. Standard veno -venous bypass was used in 10 patients with single bypass utilized for the remainder. Actuarial patient survival for all patients at 1, 2, a nd 4 years was 88, 85, and 79%, respectively. There was no significant difference in patients with or without PVT. Patients with PVT had poo rer graft survival than patients without PVT (86% vs 65%, 1 year; 81% vs 65%, 2 years; 81% vs 61%, 4 years; P = 0.03); however, this was not related to technical problems with the portal venous inflow. PVT occu rred in 26% of U.S. veterans undergoing liver transplantation. These p atients had significantly higher operative blood loss and poorer graft survival. The high incidence of postnecrotic cirrhosis in a predomina ntly male group of patients with advanced disease, as is evident by th e high mean Childs-Pugh score and UNOS status, perhaps accounts for ou r observations. (C) 1996 Academic Press, Inc.