Liver Transplantation in Patients with Portal Vein Thrombosis: Comparing Pre-MELD and MELD era

Background: Portal vein thrombosis (PVT) used to be a relative contraindication for live rt ransplantatio n(LT).Thisobstacle ha sbe end e altwi thfollowingtheimpro vementofLT-relatedte chniques.Obje ctiv e:To c omp ar etheou tcomeof ad ultpatientswithPVTwh ounde rwent LTbefore andaftera dopt-ingMELD.Meth ods:We retro spectivelysear chedo u rdat a basefordeceas e ddonorLT reci pient swhoha dPVT,wereoperatedbetwe en 1990an d200 9,andwe re18years oldorm ore.The o utcomeo fpat ient sopera t edinpre-MELDera (1990–2 001)was t hencomparedwiththatofthoseo peratedinM ELDera (2002–2009) .Resul ts :TheincidenceofpatientsundergoingLTw it hPVTha sincre asedf ro m1.2 %(491/ 40 ,73 0) inpr e-MELDerato6 % (2540/42,601)inMELDe r a ( p<0 .0 1).Pati e n t swithPVTinMEL Der awereol der (53 .6vs50.5), ha dhig her ca lcul atedMELD(21.3vs18.9),shor terlengthofho spi talst ayafterLT(25vs2 1.7da ys), mor elikel ytod evelop HCC(14.8 %vs0),andmo rel ike lyto receiveDCDallograft(3.9%vs0.8%).Donorriskindiceswerecomparableinbothgroups(1. 9vs 1 .9 ). The medianwaitingti m ebeforet rans p lanta tionde cre as e dduringM ELDera(7 1 vs99d ays).Al lograft and pa tientssur vivalwas c omparablebetweenthetwoer as.However, allograftandpa tients survivalrateswerelowerinpatientswi t hP VTcompa redtothosewithout.InCoxregres s ionan alysis, PV T wasassocia tedwithwor se allogr aft( HR=1.3,95 %CI:1.2–1.4, p< 0.00 1)andp atientsurviva l(HR= 1.3,95 %CI:1 .2 –1.5,p <0. 00 1 )compa redtono n-PV Tpatients.Conc lusions:Theincide n c eofpa tie nt swithPVTha sincr easedi nM EL Derawithou timprovementinoutcomes. Don orandr ecipientschara cterist icschangedi nMELDe ra.PVT iss tillas sociat e d withp ooroutcomesc ompar edto patie ntsw i thou t P VT.