Obesity is an independent risk factor for pre-transplant portal vein thrombosis in liver recipients

BMC Gastroenterology

Joaquín Martínez-López¹  Enrique Moreno²  Carlos Jimenez²  Alvaro García-Sesma²  Carmen Ribera¹  Rosalía Bustelos³  Silvia Grande¹  Rosa Ayala⁴ 

[1] Hematology Department, 12 De Octubre University Hospital, Avenida Córdoba s/n, 28041, Madrid, Spain;General Surgery Alimentary Tract and Abdominal Organ Transplantation Department, 12 De Octubre University Hospital, Madrid, Spain;Hematology Department, Sureste Hospital (Arganda), Madrid, Spain;Complutense De Madrid University, Madrid, Spain

关键词: Liver transplant recipient;    Portal vein thrombosis;    Thrombophilia;   

Others  :  1088689
DOI  :  10.1186/1471-230X-12-114

 received in 2011-11-06, accepted in 2012-07-26,  发布年份 2012

【 摘 要 】

Background

Portal vein thrombosis is a frequent complication in end-stage cirrhosis with a considerable peri-operative risk for liver transplant candidates. We aimed to characterize the pre-transplant portal vein thrombosis in a cohort of liver transplant recipients, and to identify independent risk factors for this complication.

Methods

380 consecutive primary orthotopic liver transplants were performed in the Digestive Surgery Department of “12 de Octubre” Hospital (Madrid, Spain), between January 2001 and December 2006. The main risk factors considered were smoking, obesity, metabolic disorders, previous immobility, surgery or trauma, nephrotic syndrome, associated tumor, inflammatory disease, neoplasm myeloprolipherative. Furthermore we have reported genetic thrombophilia results for 271 recipients.

Results

Sixty-two (16.3%) patients developed pre-transplant portal vein thrombosis and its presence had no impact in the overall survival of liver recipients. Obesity was the only independent risk factor for pre-transplant portal vein thrombosis.

Conclusion

We recommend close control of cardiovascular factors in patients with liver cirrhosis in order to avoid associated thrombosis.

【 授权许可】

   
2012 Ayala et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Francoz C, Belghiti J, Vilgrain V, Sommacale D, Paradis V, Condat B, Denninger MH, Sauvanet A, Valla D, Durand F: Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut 2005, 54(5):691-697.
• [2]Harmanci O, Bayraktar Y: Portal hypertension due to portal venous thrombosis: etiology, clinical outcomes. World J Gastroenterol 2007, 13(18):2535-2540.
• [3]Stieber AC, Zetti G, Todo S, Tzakis AG, Fung JJ, Marino I, Casavilla A, Selby RR, Starzl TE: The spectrum of portal vein thrombosis in liver transplantation. Ann Surg 1991, 213(3):199-206.
• [4]Shaked A, Busuttil RW: Liver transplantation in patients with portal vein thrombosis and central portacaval shunts. Ann Surg 1991, 214(6):696-702.
• [5]Lendoire J, Raffin G, Cejas N, Duek F, Barros Schelotto P, Trigo P, Quarin C, Garay V, Imventarza O: Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome. HPB (Oxford) 2007, 9(5):352-356.
• [6]Ayala R, Martinez-Lopez J, Cedena T, Bustelos R, Jimenez C, Moreno E, Ribera C: Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients. BMC Gastroenterol 2011, 11(1):130. BioMed Central Full Text
• [7]Rapado I, Grande S, Albizua E, Ayala R, Hernandez JA, Gallardo M, Gilsanz F, Martinez-Lopez J: High resolution melting analysis for JAK2 Exon 14 and Exon 12 mutations: a diagnostic tool for myeloproliferative neoplasms. J Mol Diagn 2009, 11(2):155-161.
• [8]Feng S, Humar A, Pomfret E, Fishbein T, Gaber O: Surgical challenges in transplantation: the Fourth Annual American Society of Transplant Surgeons' State-of-the-Art Winter Symposium. Am J Transplant 2005, 5(3):428-435.
• [9]Goldhaber SZ, Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Speizer FE, Willett WC, Hennekens CH: A prospective study of risk factors for pulmonary embolism in women. JAMA 1997, 277(8):642-645.
• [10]Stein PD, Beemath A, Olson RE: Obesity as a risk factor in venous thromboembolism. Am J Med 2005, 118(9):978-980.
• [11]Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW: Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008, 117(1):93-102.
• [12]Allman-Farinelli MA: Obesity and venous thrombosis: a review. Semin Thromb Hemost 2011, 37(8):903-907.
• [13]van Langevelde K, Flinterman LE, van Hylckama Vlieg A, Rosendaal FR, Cannegieter SC: Broadening the factor V Leiden paradox: pulmonary embolism and deep-vein thrombosis as two sides of the spectrum. Blood 2012, 120(5):933-946.
• [14]Lamattina JC, Foley DP, Fernandez LA, Pirsch JD, Musat AI, D'Alessandro AM, Mezrich JD: Complications associated with liver transplantation in the obese recipient. Clin Transplant 2012. first published on Jun 13
• [15]Pearson V, Ruzas C, Krebs NF, Goldenberg NA, Manco-Johnson MJ, Bernard TJ: Overweight and Obesity Are Increased in Childhood-Onset Cerebrovascular Disease. J Child Neurol 2012. first published on May 30, 2012
• [16]Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Morillas R, Escorsell A, Garcia-Pagan JC, Patch D, Matloff DS, et al.: Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 2011, 54(2):555-561.
• [17]Egesel T, Buyukasik Y, Dundar SV, Gurgey A, Kirazli S, Bayraktar Y: The role of natural anticoagulant deficiencies and factor V Leiden in the development of idiopathic portal vein thrombosis. J Clin Gastroenterol 2000, 30(1):66-71.
• [18]Janssen HL, Meinardi JR, Vleggaar FP, van Uum SH, Haagsma EB, van Der Meer FJ, van Hattum J, Chamuleau RA, Adang RP, Vandenbroucke JP, et al.: Factor V Leiden mutation, prothrombin gene mutation, and deficiencies in coagulation inhibitors associated with Budd-Chiari syndrome and portal vein thrombosis: results of a case–control study. Blood 2000, 96(7):2364-2368.
• [19]Primignani M, Martinelli I, Bucciarelli P, Battaglioli T, Reati R, Fabris F, Dell'era A, Pappalardo E, Mannucci PM: Risk factors for thrombophilia in extrahepatic portal vein obstruction. Hepatology 2005, 41(3):603-608.
• [20]Denninger MH, Chait Y, Casadevall N, Hillaire S, Guillin MC, Bezeaud A, Erlinger S, Briere J, Valla D: Cause of portal or hepatic venous thrombosis in adults: the role of multiple concurrent factors. Hepatology 2000, 31(3):587-591.
• [21]Kiladjian JJ, Cervantes F, Leebeek FW, Marzac C, Cassinat B, Chevret S, Cazals-Hatem D, Plessier A, Garcia-Pagan JC, Darwish Murad S, et al.: The impact of JAK2 and MPL mutations on diagnosis and prognosis of splanchnic vein thrombosis: a report on 241 cases. Blood 2008, 111(10):4922-4929.
• [22]Plessier A, Darwish-Murad S, Hernandez-Guerra M, Consigny Y, Fabris F, Trebicka J, Heller J, Morard I, Lasser L, Langlet P, et al.: Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010, 51(1):210-218.
• [23]Englesbe MJ, Kubus J, Muhammad W, Sonnenday CJ, Welling T, Punch JD, Lynch RJ, Marrero JA, Pelletier SJ: Portal vein thrombosis and survival in patients with cirrhosis. Liver Transpl 2010, 16(1):83-90.
• [24]Davidson BR, Gibson M, Dick R, Burroughs A, Rolles K: Incidence, risk factors, management, and outcome of portal vein abnormalities at orthotopic liver transplantation. Transplantation 1994, 57(8):1174-1177.
• [25]Molmenti EP, Roodhouse TW, Molmenti H, Jaiswal K, Jung G, Marubashi S, Sanchez EQ, Gogel B, Levy MF, Goldstein RM, et al.: Thrombendvenectomy for organized portal vein thrombosis at the time of liver transplantation. Ann Surg 2002, 235(2):292-296.
• [26]Manzanet G, Sanjuan F, Orbis P, Lopez R, Moya A, Juan M, Vila J, Asensi J, Sendra P, Ruiz J, et al.: Liver transplantation in patients with portal vein thrombosis. Liver Transpl 2001, 7(2):125-131.
• [27]Dumortier J, Czyglik O, Poncet G, Blanchet MC, Boucaud C, Henry L, Boillot O: Eversion thrombectomy for portal vein thrombosis during liver transplantation. Am J Transplant 2002, 2(10):934-938.
• [28]Gimeno FA, Calvo J, Loinaz C, Meneu JC, Perez B, Gomez R, Jimenez C, Abradelo M, Moreno A, Sesma A, et al.: Comparative analysis of the results of orthotopic liver transplantation in patients with and without portal vein thrombosis. Transplant Proc 2005, 37(9):3899-3903.