Portal vein thrombosis and renal dysfunction: a national comparative study of liver transplant recipients for NAFLD versus alcoholic cirrhosis |
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Authors: | Michele Molinari Carlos Fernandez-Carrillo Dongling Dai Jorgensen Dana Ana Clemente-Sanchez Stalin Dharmayan Christof Kaltenmeier Hao Liu Jaideep Behari Vikrant Rachakonda Swaytha Ganesh Christopher Hughes Amit Tevar Hasan Al Harakeh Bishoy Emmanuel Abhinav Humar Ramon Bataller |
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Institution: | 1. Department of Surgery, UPMC Montefiore Hospital, Pittsburgh, PA, USA;2. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Department of Surgery, University of Leeds, Leeds, UK;3. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA |
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Abstract: | The prevalence of portal vein thrombosis (PVT), renal dysfunction (RD), and simultaneous PVT/RD in liver transplantation (LT) is poorly understood. We analyzed the prevalence of PVT, RD, simultaneous PVT/RD, and the outcomes of adult recipients of LT for nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) between 2006 and 2016 in the United States. We found that the prevalence of PVT (7.2% → 11.3%), RD (33.8% → 39.2%), and simultaneous PVT/RD (2.4% → 4.5%) has increased significantly over the study period (all P-values <0.05). NAFLD patients had a higher proportion of PVT (14.8% vs. 9.2%), RD (45.0% vs. 42.1%), and simultaneous PVT/RD (6.5% vs. 3.9%; all P-values <0.05). 90-day mortality was 3.8%, 6.3%, 6.8%, and 9.8% for PVT(−)/RD(−), PVT(−)/RD(+), PVT(+)/RD(−), and PVT(+)/RD(+) recipients, respectively (P < 0.01). 5-year survival was 82.1%, 75.5%, 74.8%, and 71.1% for PVT(−)/RD(−), PVT(−)/RD(+), PVT(+)/RD(−), and PVT(+)/RD(+) recipients, respectively (P < 0.05). In conclusion, the prevalence of PVT, RD, and simultaneous PVT/RD has increased among LT recipients, especially for those with NAFLD. The short- and long-term outcomes of recipients with PVT, RD, and simultaneous PVT/RD were inferior to patients without those risk factors irrespective of their indication for LT. No differences in patient outcomes were found between ALD and NAFLD recipients after stratification by risk factors. |
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Keywords: | alcoholic liver disease interaction liver transplantation nonalcoholic fatty liver disease nonalcoholic steatohepatitis overall survival perioperative mortality portal vein thrombosis renal dysfunction |
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