Portal vein thrombosis is not associated with increased mortality among patients with cirrhosis

Abstract

Background & aims: Portal vein thrombosis (PVT) is common in patients with cirrhosis and may have adverse clinical consequences. We investigated whether PVT is associated with survival in patients with cirrhosis.

Methods: Using the United Network for Organ Sharing registries from 2002 through 2013, we followed a cohort of transplant-naive adults with cirrhosis without hepatocellular carcinoma (N = 66,506) from the time of transplant listing until the time of liver transplantation or death before transplantation. We used Cox proportional hazards analysis and competing risks analysis to compare patients who had PVT at the time of listing (n = 2207) with those who did not (n = 64,299) with regard to the risk of transplantation or death before transplantation, after adjusting for important baseline characteristics.

Results: During a mean follow-up period of 1.78 years, 17,757 (27%) patients died before liver transplantation, 29,179 (44%) patients underwent transplantation, and 19,570 (29%) patients were still alive without having undergone transplantation. Compared with patients who did not have PVT, patients with PVT had lower mortality (adjusted hazard ratio [AHR], 0.88; 95% confidence interval [CI], 0.81-0.96), a similar risk of transplantation (AHR, 0.95; 95% CI, 0.89-1.02), and a lower risk of the combined outcome of death or transplantation (AHR, 0.92; 95% CI, 0.88-0.97). Similar results were found by competing risks analyses. Independent predictors of mortality included age, model for end-stage liver disease score, serum albumin level, ascites, encephalopathy, diabetes, hepatitis C virus infection, and low body mass index (<24.4 kg/m(2)).

Conclusions: Among patients with cirrhosis on liver transplant waiting lists, patients with PVT have lower mortality than patients without PVT.

Keywords: Cirrhosis; Liver Transplantation; MELD; Mortality; Portal Vein Thrombosis; Survival; UNOS.