Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2024; 16(2): 241-250
Published online Feb 27, 2024. doi: 10.4254/wjh.v16.i2.241
Predictors of portal vein thrombosis after splenectomy in patients with cirrhosis
Ting Li, Li-Li Wang, Ya-Ping Li, Jian Gan, Xi-Sheng Wei, Xiao-Rong Mao, Jun-Feng Li
Ting Li, Ya-Ping Li, Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710000, Shaanxi Province, China
Li-Li Wang, Department of Radiology, First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Jian Gan, Department of Gastroenterology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, Shandong Province, China
Xi-Sheng Wei, Xiao-Rong Mao, Jun-Feng Li, Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Co-first authors: Ting Li and Li-Li Wang.
Co-corresponding authors: Jun-Feng Li and Xiao-Rong Mao.
Author contributions: Li T and Wang LL contributed equally to this work; Li JF and Mao XR designed the research study; Li T and Wang LL performed the research; Li YP, Gan J and Wei XS contributed new reagents and analytic tools; Li T and Wang LL analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript. Li T and Wang LL contributed equally to this work as co-first authors; Li JF and Mao XR contributed equally to this work as co-corresponding authors. The reasons for designating Li JF and Mao XR as co-corresponding authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper’s quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-corresponding authors best reflects this diversity. This also promonthstes the monthsst comprehensive and in-depth examination of the research topic, ultimately enriching readers’ understanding by offering various expert perspectives. Third, Li JF and Mao XR contributed efforts of equal substance throughout the research process. The choice of these researchers as co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Li JF and Mao XR as co-corresponding authors of is fitting for our manuscript as it accurately reflects our team’s collaborative spirit, equal contributions, and diversity.
Supported by the National Natural Science Foundation of China, No. 81800528; Natural Science Foundation of Gansu Province, No. 20JR5RA364; and Key Research and Development Project of Gansu Province, No. 20YF2FA011.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the first hospital of Lanzhou University (Approval No. LDYYLL2019-209).
Informed consent statement: Informed consent was obtained from the patients.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commonthsns Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommonthsns.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Feng Li, Doctor, PhD, Professor, Department of Infectious Diseases, The First Hospital of Lanzhou University, No. 1 Donggangxi Road, Lanzhou 730000, Gansu Province, China. junfenglee@126.com
Received: October 22, 2023
Peer-review started: October 22, 2023
First decision: December 8, 2023
Revised: December 21, 2023
Accepted: January 8, 2024
Article in press: January 8, 2024
Published online: February 27, 2024
Processing time: 127 Days and 18.2 Hours
ARTICLE HIGHLIGHTS
Research background

Splenectomy has been considered an effective option to reverse thrombocytopenia in cirrhosis patients with splenomegaly. Thus, splenectomy have been widely used in Asia for the treatment of esophagogastric variceal hemonthsrrhage and hypersplenism caused by cirrhotic portal hypertension. However, splenectomy can increase the risk of portal vein thrombosis (PVT) at least 10 times. The incidence of PVT was 18.9%-57.0% after splenectomy, which was significantly higher than the natural incidence in patients with cirrhosis without surgery. PVT can induce or aggravate upper gastrointestinal bleeding, hepatic encephalopathy, and ascites, increase the risk of intestinal ischemia or intestinal necrosis, reduce the survival of patients and grafts after liver transplantation, and result in chronic cavernous transformation of the portal vein system in the long term.

Research monthstivation

Splenectomy plays an important role in the treatment of cirrhosis. Splenectomy is widely used for the treatment of esophagogastric variceal haemonthsrrhage and hypersplenism owing to cirrhotic portal hypertension. However, splenectomy can increase the risk of PVT at least 10 times. Our study aims to seek the risk factors of PVT after splenectomy and early sensitive indicators, to provide a predictive basis for early PVT and reduce the incidence of PVT.

Research objectives

To establish the risk factors for PVT after splenectomy and early sensitive indicators, to provide a predictive basis for early PVT.

Research methods

A total of 45 patients with cirrhosis who underwent splenectomy were consecutively enrolled from January 2017 to December 2018. The incidence of PVT at 1 months, 3 months, and 12 months after splenectomy in patients with cirrhosis was observed. The hematological indicators, biochemical and coagulation parameters, and imaging features were recorded at baseline and at each observation point. The univariable, multivariable, receiver operating characteristic curve and time-dependent curve analyses were performed.

Research results

PVD ≥ 14.5 mm and monthsdel‎ end-stage liver disease (MELD) > 10 were independent predictors of PVT at 1-months, 3-months, and 12-months after splenectomy. The patients with PVD ≥ 14.5 mm and/or MELD > 10 in preoperative, preoperative treatment of reducing portal vein pressure and improving liver function may help to reduce the incidence of PVT after splenectomy. However, monthsre large-scale studies will be needed to provide reliable and effective evidence for the specific time, drug selection and dosage of anticoagulants.

Research conclusions

Portal vein diameter (PVD) ≥ 14.5 mm was independent predictors of PVT at 1-months, 3-months, and 12-months after splenectomy. End-stage liver disease score > 10 was independent predictors of PVT at 1-months, 3-months, and 12-months after splenectomy. The patients with PVD ≥ 14.5mm and/or end-stage liver disease score > 10 in preoperative, preoperative treatment of reducing portal vein pressure and improving liver function may help to reduce the incidence of PVT after splenectomy.

Research perspectives

How to prophylactic anticoagulation therapy after splenectomy? Anticoagulant therapy of PVT should be explored.