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Updated: Apr 27, 2026
New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation
Published on: June 27, 2025
Liver Transplantation in Patients with Portal Vein Thrombosis: Comparing Pre-MELD and MELD era
R F Saidi1, N Jabbour1, Y F Li1
1Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Background:
Portal vein thrombosis (PVT) used to be a relative contraindication for liver transplantation (LT). This obstacle has been dealt with following the improvement of LT-related techniques.
Objective:
To compare the outcome of adult patients with PVT who underwent LT before and after adopting MELD.
Methods:
We retrospectively searched our database for deceased donor LT recipients who had PVT, were operated between 1990 and 2009, and were 18 years old or more. The outcome of patients operated in pre-MELD era (1990-2001) was then compared with that of those operated in MELD era (2002-2009).
Results:
The incidence of patients undergoing LT with PVT has increased from 1.2% (491/40,730) in pre-MELD era to 6% (2540/42,601) in MELD era (p<0.01). Patients with PVT in MELD era were older (53.6 vs 50.5), had higher calculated MELD (21.3 vs 18.9), shorter length of hospital stay after LT (25 vs 21.7 days), more likely to develop HCC (14.8% vs 0), and more likely to receive DCD allograft (3.9% vs 0.8%). Donor risk indices were comparable in both groups (1.9 vs 1.9). The median waiting time before transplantation decreased during MELD era (71 vs 99 days). Allograft and patients survival was comparable between the two eras. However, allograft and patients survival rates were lower in patients with PVT compared to those without. In Cox regression analysis, PVT was associated with worse allograft (HR=1.3, 95% CI: 1.2-1.4, p<0.001) and patient survival (HR=1.3, 95% CI: 1.2-1.5, p<0.001) compared to non-PVT patients.
Conclusions:
The incidence of patients with PVT has increased in MELD era without improvement in outcomes. Donor and recipients characteristics changed in MELD era. PVT is still associated with poor outcomes compared to patients without PVT.
Insights
The incidence of portal vein thrombosis (PVT) in liver transplantation (LT) increased after adopting the MELD system, but patient outcomes did not improve. PVT remains associated with poorer survival rates compared to patients without PVT.
Area of Science:
- Hepatology
- Transplantation Surgery
- Vascular Surgery
Background:
- Portal vein thrombosis (PVT) was historically a contraindication for liver transplantation (LT).
- Advances in LT techniques have made transplantation feasible even with PVT.
- The introduction of the Model for End-Stage Liver Disease (MELD) score has influenced LT practices.
Purpose of the Study:
- To compare outcomes of adult LT recipients with PVT before and after the adoption of the MELD system.
- To analyze changes in patient and donor characteristics associated with PVT and LT across different eras.
- To evaluate the impact of PVT on allograft and patient survival in the context of MELD-era LT.
Main Methods:
- Retrospective analysis of deceased donor LT recipients with PVT (1990-2009).
- Comparison of outcomes between the pre-MELD era (1990-2001) and the MELD era (2002-2009).
- Utilized Cox regression analysis to assess the impact of PVT on survival.
Main Results:
- Incidence of PVT in LT recipients rose significantly from 1.2% to 6% post-MELD adoption.
- MELD-era PVT patients were older, had higher MELD scores, shorter hospital stays, and increased HCC development.
- Despite changes in donor/recipient factors and decreased waiting times, allograft and patient survival rates remained comparable between eras but were lower for PVT patients.
- PVT was independently associated with worse allograft and patient survival (HR=1.3).
Conclusions:
- The increased incidence of PVT in LT during the MELD era has not led to improved patient outcomes.
- Significant shifts in donor and recipient characteristics were observed in the MELD era.
- PVT continues to be a significant risk factor associated with poorer outcomes in liver transplantation.
