Journal of Clinical Medicine

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Special Issue Editors

Dr. Antonio Cuadrado

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Guest Editor

1. Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, 39008 Santander, Spain
2. Group of Clinical and Translational Research in Digestive Diseases, Health Research Institute Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
3. Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
Interests: liver transplantation; immunosuppression; rejection; graft dysfunction; cirrhosis; acute-on-chronic liver failure; portal vein thrombosis; vascular liver diseases

Dr. Ángela Puente

E-Mail Website
Guest Editor

Gastroenterology and Hepatology Department, University, Hospital Marqués de Valdecilla, 39008 Santander, Spain
Interests: digestive diseases; portal hypertension; cirrhosis complications; gastroenterology; hepatology

Special Issue Information

Dear Colleagues,

Portal Vein Thrombosis (PVT) is a heterogeneous condition with respect to etiology, manifestations, natural history, and therapeutic options. PVT is rare in patients without cirrhosis in whom it usually develops in the presence of an underlying prothrombotic condition. In the setting of cirrhosis, however, PVT is a frequent event that occurs in 0.6 to 15.8% of patients depending on the severity of liver disease. Once PVT is present, its impact on the natural history of cirrhosis is not clear, raising the question of whether PVT is the consequence or the cause of liver disease progression. Nevertheless, in the liver transplant (LT) candidate, the presence of PVT at the time of transplant is associated with increased posttransplant mortality, especially in cases of extensive PVT thromboses requiring nonanatomic venous anastomoses or bypass grafts that increase the technical challenge. Moreover, in some patients with cirrhosis, whether to treat PVT or not is still a debatable issue, given its controversial impact on the natural history and prognosis. In recent years, there have been important advances in the diagnosis, characterization and treatment of this entity, such as the advancement of endovascular treatment (i.e., transjugular intrahepatic portosystemic shunt or portal vein recanalization). However, there are still many unknowns about the pathophysiology, precipitating risk factors, natural history and treatment, which must be clarified in the coming years by well-designed studies.

With this Special Issue, we hope to encourage submissions that discuss the current state of the art, address existing knowledge gaps, and focus on ongoing controversies related to the pathogenesis, diagnostic, prognosis, and therapeutic management of portal vein thrombosis and its complications.

Dr. Antonio Cuadrado
Dr. Ángela Puente
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

portal vein thrombosis
cirrhosis
liver transplant
portal hypertension
anticoagulants
transjugular intrahepatic portosystemic shunt
TIPS
portal vein recanalization
non-cirrhotic portal vein obstruction
thrombophilic conditions

Published Papers (2 papers)

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Research

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12 pages, 1229 KiB

Open AccessArticle

Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients

by Antonio Cuadrado, José Ignacio Fortea, Carlos Rodríguez-Lope, Ángela Puente, Vanesa Fernández-Vilchez, Victor Jose Echavarria, Federico José Castillo Suescun, Roberto Fernández, Juan Andrés Echeverri, Mar Achalandabaso, Enrique Toledo, Raúl Pellón, Juan Carlos Rodríguez Sanjuan, Javier Crespo and Emilio Fábrega

J. Clin. Med. 2023, 12(17), 5457; https://doi.org/10.3390/jcm12175457 - 23 Aug 2023

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Abstract

Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new prognostic tools, such as pre-MORAL or RETREAT risks, is necessary to improve recurrence prediction. A retrospective study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain, between 2010 and 2019 to determine the rate of TR in LT patients and identify associated factors. Patients with liver-kidney transplantation, re-transplantation, HIV infection, survival less than 90 days, or incidental HCC were excluded. Data on demographic, liver disease-related, LT, and tumor-related variables, as well as follow-up records, including TR and death, were collected. TR was analyzed using the Log-Rank test, and a multivariate Cox regression analysis was performed. The study was approved by the IRB of Cantabria. TR occurred in 13.6% of LT patients (95% CI = 7.3–23.9), primarily as extrahepatic recurrence (67%) within the first 5 years (75%). Increased TR was significantly associated with higher Body Mass Index (BMI) (HR = 1.3 [95% CI = 1.1–1.5]), vascular micro-invasion (HR = 8.8 [1.6–48.0]), and medium (HR = 20.4 [3.0–140.4]) and high pre-MORAL risk (HR = 30.2 [1.6–568.6]). TR also showed a significant correlation with increased mortality. Conclusions: LT for HCC results in a 13.6% rate of tumor recurrence. Factors such as BMI, vascular micro-invasion, and medium/high pre-MORAL risk are strongly associated with TR following LT. Full article

(This article belongs to the Special Issue Pathophysiology, Diagnosis, and Management of Portal Vein Thrombosis)

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Review

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14 pages, 602 KiB

Open AccessReview

Suppurative Thrombosis of the Portal Vein (Pylephlebits): A Systematic Review of Literature

by Dorde Jevtic, Tatjana Gavrancic, Ivana Pantic, Terri Nordin, Charles W. Nordstrom, Marina Antic, Nikola Pantic, Marija Kaljevic, Bojan Joksimovic, Milan Jovanovic, Emilia Petcu, Mladen Jecmenica, Tamara Milovanovic, Lawrence Sprecher and Igor Dumic

J. Clin. Med. 2022, 11(17), 4992; https://doi.org/10.3390/jcm11174992 - 25 Aug 2022

Cited by 16 | Viewed by 2509

Abstract

Suppurative portal vein thrombosis (pylephlebitis) is an uncommon condition usually associated with an intra-abdominal infection or inflammatory process. In this study, we aimed to synthesize data on previously published cases according to the PRISMA guidelines. A total of 103 patients were included. Patients were more commonly male (71.8%) and had a mean age of 49 years. The most common infection associated with pylephlebitis was diverticulitis (n = 29, 28.2%), and Escherichia coli was the most isolated pathogen (n = 21, 20.4%). Blood cultures were positive in 64 cases (62.1%). The most common site of thrombosis was the main portal vein (PV) in 59 patients (57.3%), followed by the superior mesenteric vein (SMV) in 40 patients (38.8%) and the right branch of the PV in 30 patients (29.1%). Sepsis developed in 60 patients (58.3%). The mortality rate in our review was 8.7%, and independent risk factors for mortality were the presence of pertinent comorbidities (OR 5.5, p = 0.02), positive blood cultures (OR 2.2, p = 0.02), and sepsis (OR 17.2, p = 0.049). Full article

(This article belongs to the Special Issue Pathophysiology, Diagnosis, and Management of Portal Vein Thrombosis)

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