Portal vein thrombosis after hematopoietic cell transplantation: Frequency, treatment and outcome

K. Kikuchi, R. Rudolph, C. Murakami, K. Kowdley, G. B. McDonald

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Patients who develop veno-occlusive disease (VOD) of the liver may have low plasma levels of the natural anticoagulants protein C and antithrombin III, but large vessel thromboses are not commonly reported in these patients. We reviewed the records of 1847 consecutive patients for evidence of portal vein thrombosis. Eight patients (0.4%) developed portal vein thrombosis (PVT) at a median of day +28 (range 3-58). All patients had clinical evidence of VOD with ascites, a median total serum bilirubin 11.9 mg/dl, and median weight gain from baseline of 7.9%. Median plasma levels of antithrombin III and protein C were low (36% and 21%, respectively). Four patients with PVT died of severe VOD and multi-organ failure, but PVT did not contribute to death. We conclude that PVT is a rare complication of hematopoietic cell transplant and is associated with hepatic VOD. We speculate that PVT resulted from diminished portal venous flow (related to hepatic sinusoidal obstruction to blood flow) and a hypercoagulable state (related to low circulating antithrombin III and protein C levels). Prognosis depended on the severity of the underlying VOD and not PVT per se, suggesting that treatments directed solely toward dissolution of portal vein thrombi should be used with caution in this setting.

Original languageEnglish (US)
Pages (from-to)329-333
Number of pages5
JournalBone Marrow Transplantation
Volume29
Issue number4
DOIs
StatePublished - Jan 1 2002

Fingerprint

Cell Transplantation
Portal Vein
Thrombosis
Antithrombin III
Protein C
Antithrombin Proteins
Hepatic Veno-Occlusive Disease
Bilirubin
Ascites
Anticoagulants
Weight Gain
Liver Diseases
Transplants
Liver
Serum

Keywords

  • Antithrombin III
  • Hematopoietic cell transplantation
  • Portal vein thrombosis
  • Protein C
  • Thrombolytic therapy
  • Veno-occlusive disease

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Portal vein thrombosis after hematopoietic cell transplantation : Frequency, treatment and outcome. / Kikuchi, K.; Rudolph, R.; Murakami, C.; Kowdley, K.; McDonald, G. B.

In: Bone Marrow Transplantation, Vol. 29, No. 4, 01.01.2002, p. 329-333.

Research output: Contribution to journalArticle

Kikuchi, K. ; Rudolph, R. ; Murakami, C. ; Kowdley, K. ; McDonald, G. B. / Portal vein thrombosis after hematopoietic cell transplantation : Frequency, treatment and outcome. In: Bone Marrow Transplantation. 2002 ; Vol. 29, No. 4. pp. 329-333.
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abstract = "Patients who develop veno-occlusive disease (VOD) of the liver may have low plasma levels of the natural anticoagulants protein C and antithrombin III, but large vessel thromboses are not commonly reported in these patients. We reviewed the records of 1847 consecutive patients for evidence of portal vein thrombosis. Eight patients (0.4{\%}) developed portal vein thrombosis (PVT) at a median of day +28 (range 3-58). All patients had clinical evidence of VOD with ascites, a median total serum bilirubin 11.9 mg/dl, and median weight gain from baseline of 7.9{\%}. Median plasma levels of antithrombin III and protein C were low (36{\%} and 21{\%}, respectively). Four patients with PVT died of severe VOD and multi-organ failure, but PVT did not contribute to death. We conclude that PVT is a rare complication of hematopoietic cell transplant and is associated with hepatic VOD. We speculate that PVT resulted from diminished portal venous flow (related to hepatic sinusoidal obstruction to blood flow) and a hypercoagulable state (related to low circulating antithrombin III and protein C levels). Prognosis depended on the severity of the underlying VOD and not PVT per se, suggesting that treatments directed solely toward dissolution of portal vein thrombi should be used with caution in this setting.",
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