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Obesity linked with pre-transplant PVT in liver transplant patients

Obese patients who underwent liver transplant were more likely to have developed portal vein thrombosis before the procedure compared with nonobese patients in a recent study.

Researchers in Spain evaluated 380 patients who underwent primary orthotopic liver transplants between January 2001 and December 2006, along with genetic thrombophilia results for 271 of these participants. Incidents of portal vein thrombosis (PVT) within the cohort were recorded during follow-up (median, 20.23 months). Potential risk factors for the condition were assessed, and the impact of PVT on overall survival rates was calculated.

Before transplant, PVT developed in 62 participants. Risk factors associated with pre-transplant PVT other than terminal cirrhosis included younger age (P=.011 for children vs. adults), diabetes (P=.043), obesity (P=.004) and myeloproliferative syndrome (P=.003). Obesity was the only risk factor independently associated with portal vein thrombosis through multivariate analysis (HR=13.161, P=.016).

Results from the genetic study indicated no relationship between PVT before transplant and evaluated genetic mutations, including Factor V Leiden, prothrombin 20210A and C677T MTHFR. Overall survival rate among transplant recipients was not impacted by thrombosis (79.18% of those with PVT vs. 79.66% without, P=.989).

“To the best of our knowledge, this is the first extensive genetic thrombophilia study in a large cohort of liver recipients,” the researchers wrote. “Previously, obesity has been considered to be a risk factor for the venous thromboembolism as well as arterial thrombosis, and was also previously reported as an independent risk factor for clinical decompensation in patients with cirrhosis, but it had not been previously associated with PVT. … We stress the importance of controlling the cardiovascular factors in patients with liver cirrhosis.”