Background : Portal vein thrombosis poses a significant challenge in liver transplantation. This study aims to describe the management and outcomes of liver transplantation in patients with portal vein thrombosis in a high-volume institution.

Methods : We conducted a retrospective cohort analysis of transplanted patients in our institution. Relevant clinical features were evaluated.

Results : Since the start of the transplantation program, 2675 liver transplants have been performed in our institution. 118 of these patients (4,4%) were diagnosed with portal vein thrombosis either before or during the transplant. Average MELD score was 16. In most patients the diagnosis was made preoperatively (87, 73,7%) and 49 (41,5%) were taking anticoagulant medication at the time of transplant. Portal vein thrombosis was categorized according to Yerdel: the most common type was grade I thrombosis (n= 34, 28,8%). Most patients (109, 92,4%) underwent thrombectomy and direct anastomosis. Retransplant rate was 12,7% (n=15). There was a slight reduction in early thrombotic complications (60% vs 40%, p=0,084) in patients treated with anticoagulants before transplant, with no statistically significant effect on major bleedings. There was a trend towards better overall survival amongst patients in whom the thrombosis was diagnosed before transplant (1 year: 80,5% vs 74,2%).

Conclusions : Morbidity and mortality in this population did not differ significantly from previous studies in non-thrombotic patients in our institution. Portal vein thrombosis is common in patients with cirrhosis, and it is important to screen and treat accordingly to improve transplant outcomes and plan alternative techniques to restore portal blood flow. Our study supports that PVT should no longer be considered an absolute contraindication for liver transplant.