To investigate the risk factors and treatment methods of portal vein thrombosis (PVT) after liver transplantation (LT) in adult liver cirrhosis recipients.

The clinical data of 596 adult cirrhosis patients undergoing LT in the Organ transplantation Center of Tianjin First Central Hospital from January 2018 to June 2022 were analyzed, and the overall cases were divided into PVT group (32 cases) and non-PVT group (564 cases) according to postoperative PVT. Unvariate and multivariate analysis were used to screen risk factors for PVT formation after LT and to compare survival rates between the two groups.

Out of the 596 LT recipients included in this study, the overall incidence of postoperative PVT was 5.37% (32/596). Multivariate analysis revealed that, the presence of large spontaneous portosystemic shunt (SPSS) (OR=6.716, 95%CI: 2.481-18.180), postoperative presence of portoshunt (OR=5.917, 95%CI: 1.785-19.615), preoperative grade Ⅲ-Ⅳ PVT (OR=8.368, 95%CI: 1.954-35.835) and cold ischemia time ≥10 h (OR=4.002, 95%CI: 1.183-13.537) were independent risk factors for PVT formation after LT(P<0.05). Among 32 recipients with PVT, 4 underwent surgical thrombectomy, 7 received interventional therapy, and 21 were treated with anticoagulant medications. After treatment, PVT resolved in 25 recipients, while 7 had stable PVT without clinical symptoms. A total of 5 deaths unrelated to PVT occurred. Survival analysis revealed that the 1-year, 2-year, and 3-year post-operative graft survival rates of the non-PVT group achieved 98.4%, 95.1%, and 93.6%, compared with 87.3%, 83.6%, and 78.4% in the PVT group. The difference was statistically significant (χ²=11.3, P<0.05).

The presence of large SPSS, grade Ⅲ-Ⅳ PVT, persistence of portosystemic shunt and cold ischemia time ≥10 h are independent risk factors for PVT formation after LT in adult patients with cirrhosis. For recipients of postoperative PVT formation, early diagnosis and treatment can achieve a better survival prognosis.