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Natural History and Outcomes of Cavernous Transformation of the Portal Vein in Cirrhosis

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Abstract

Background and Aims

Cavernous transformation of the portal vein can occur after portal vein thrombosis (PVT). In this study, we investigated clinical complications associated with cavernous transformation in the context of cirrhosis and PVT.

Methods

In this retrospective cohort analysis, 204 patients with cirrhosis and PVT with or without cavernous transformation were identified using MUSC’s Clinical Data Warehouse between January 1, 2013, through December 31, 2019. Complete demographic data, clinical history, and laboratory tests were abstracted from the electronic medical record.

Results

Of 204 patients, 41 (20%) had cavernous transformation. MELD, Child–Pugh, and Charlson Comorbidity Index scores were similar among groups. There were no significant differences in the prevalence of esophageal varices (with or without bleeding), splenomegaly, or hepatic encephalopathy in patients with and without cavernous transformation, although ascites tended to be lower in patients with cavernous transformation (31/41 (76%) vs 142/163 (87%), p = 0.06). Patients with cavernous transformation were significantly less likely to have hepatocellular carcinoma (HCC) (13/41 (32%) vs 81/163 (50%), p < 0.05) and had significantly lower APRI (1.4 vs 2.0, p < 0.05) and Fib-4 (4.7 vs 6.5, p < 0.05). Patients with cavernous transformation had lower 5-year mortality (12/41 (29%) vs 81/163 (49%) died, p = 0.06). The 10-year mortality of patients with cavernous transformation without HCC was significantly lower than in those without cavernous transformation (8/28 (29%) vs 46/82 (56%), respectively, p < 0.05).

Conclusions

Patients with cavernous transformation appeared to have better outcomes than those without cavernous transformation.

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Abbreviations

APRI:

AST to platelet ratio

BRTO:

Balloon occluded retrograde transvenous obliteration

EV:

Esophageal varices

EGD:

Esophagogastroduodenoscopy

Fib-4:

Fibrosis-4

MUSC:

Medical University of South Carolina

HCC:

Hepatocellular carcinoma

MWA:

Microwave ablation

MELD:

Model for end stage liver disease

NASH:

Non-alcoholic steatohepatitis

PVT:

Portal vein thrombosis

RFA:

Radiofrequency ablation

TACE:

Transarterial chemoembolization

TIPS:

Transhepatic intrajugular portosystemic shunt

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Funding

This work was supported by the NIH (DCR—P30 DK123704 and P20 GM130457, and MLA—T35 DK007431; bioinformatics elements of the work were supported by UL1 TR001450).

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Authors and Affiliations

  1. Digestive Disease Research Center, Medical University of South Carolina, 96 Jonathan Lucas Street, Clinical Sciences Building, Suite 908, Charleston, SC, 29425, USA

    Michael L. Attanasi, Halim Bou Daher & Don C. Rockey

Authors
  1. Michael L. Attanasi
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  2. Halim Bou Daher
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  3. Don C. Rockey
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Contributions

MLA—study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content. HBD—acquisition of data; critical revision of the manuscript for important intellectual content. DCR—study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; supervisory activities.

Corresponding author

Correspondence to Don C. Rockey.

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The authors have no conflicts relevant to the work presented.

Ethical approval

This study was approved by the MUSC Institutional Review Board and met all guidelines for good clinical practice.

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Attanasi, M.L., Bou Daher, H. & Rockey, D.C. Natural History and Outcomes of Cavernous Transformation of the Portal Vein in Cirrhosis. Dig Dis Sci 68, 3458–3466 (2023). https://doi.org/10.1007/s10620-023-07993-3

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