Dmitri Bezinover1, Ethan Reeder2, Faisal Aziz3, Fuat Saner4, Patrick McQuillan2, Zakiyah Kadry5, Thomas Riley6, Dmitri Guvakov2, Piotr K Janicki2. 1. Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, 17033, PA, USA. Electronic address: dbezinover@hmc.psu.edu. 2. Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, 17033, PA, USA. 3. Department of Surgery, Division of Vascular Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, 17033, PA, USA. 4. Department of General, Visceral and Transplant Surgery, Essen University Medical Center, Hufeland 55, Essen, 45147, Germany. 5. Department of Surgery, Division of Transplant Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, 17033, PA, USA. 6. Department of Medicine, Division of Hepatology, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, 17033, PA, USA.
Abstract
BACKGROUND: Perioperative vascular thrombotic events in patients undergoing liver transplantation (LT) are associated with significant morbidity and mortality. METHODS: In this retrospective UNOS database analysis, we evaluated the prevalence of portal vein thrombosis (PVT) and factors contributing to PVT development in different ethnic groups. RESULTS: Of the 47 953 LT performed between 2002 and 2015, we identified 3642 cases of PVT. African Americans (AA) had a significantly lower prevalence of PVT compared to other ethnic groups (p = 0.0001). Multivariable regression analysis confirmed that AA were less likely than other ethnicities to have PVT (OR = 0.6). AA cohort was more likely to have infectious or autoimmune causes of liver failure (OR = 1.6, 1.7 respectively) as well as higher creatinine and INR compared to other groups (OR = 1.6, 1.3 respectively). AA's were less likely to have encephalopathy, ascites, or variceal bleeding, which might indicate lower portal pressures. AA's were listed for LT later than other ethnicities and had both a lower functional status and higher MELD score at the time of registration. DISCUSSION: AA's had a significantly lower prevalence of preoperative PVT despite having a greater number of factors predisposing to thrombosis. This predisposition should be considered before instituting perioperative antithrombotic therapy.
BACKGROUND: Perioperative vascular thrombotic events in patients undergoing liver transplantation (LT) are associated with significant morbidity and mortality. METHODS: In this retrospective UNOS database analysis, we evaluated the prevalence of portal vein thrombosis (PVT) and factors contributing to PVT development in different ethnic groups. RESULTS: Of the 47 953 LT performed between 2002 and 2015, we identified 3642 cases of PVT. African Americans (AA) had a significantly lower prevalence of PVT compared to other ethnic groups (p = 0.0001). Multivariable regression analysis confirmed that AA were less likely than other ethnicities to have PVT (OR = 0.6). AA cohort was more likely to have infectious or autoimmune causes of liver failure (OR = 1.6, 1.7 respectively) as well as higher creatinine and INR compared to other groups (OR = 1.6, 1.3 respectively). AA's were less likely to have encephalopathy, ascites, or variceal bleeding, which might indicate lower portal pressures. AA's were listed for LT later than other ethnicities and had both a lower functional status and higher MELD score at the time of registration. DISCUSSION: AA's had a significantly lower prevalence of preoperative PVT despite having a greater number of factors predisposing to thrombosis. This predisposition should be considered before instituting perioperative antithrombotic therapy.
Authors: Dmitri Bezinover; Seyedehsan Navabi; Ming Wang; Zheng Li; Meryl William; Jonathan G Stine Journal: Transplant Proc Date: 2019 Jul - Aug Impact factor: 1.066
Authors: Daniel Gaballa; Dmitri Bezinover; Zakiyah Kadry; Elaine Eyster; Ming Wang; Patrick G Northup; Jonathan G Stine Journal: Liver Transpl Date: 2019-09-19 Impact factor: 5.799
Authors: Bernhard Scheiner; Patrick G Northup; Anselm B Gruber; Georg Semmler; Gerda Leitner; Peter Quehenberger; Johannes Thaler; Cihan Ay; Michael Trauner; Thomas Reiberger; Ton Lisman; Mattias Mandorfer Journal: Liver Int Date: 2020-03-04 Impact factor: 5.828