Portal Vein Thrombosis in Cirrhotic Candidates for Liver Transplantation and Its Impact on the Transplant Accessibility

Background/Objectives: Portal vein thrombosis (PVT) is prevalent among candidates for liver transplantation (LT) and may serve as a contraindication to transplantation when extensive. Given the rising prevalence of metabolic syndrome, this study aimed to identify clinical factors associated with PVT and evaluate its impact on access to the LT waiting list and the likelihood of undergoing transplantation. Methods: A retrospective cohort of 711 consecutive patients assessed for LT between 2008 and 2020 was included. Data on PVT and various clinical variables were collected, including reasons for exclusion from the waiting list and dropout rates. Multivariable logistic regression models with forward selection and bootstrap were constructed to assess factors associated with PVT, access to the waiting list, and LT. Results: PVT was identified in 11.6% of patients (n = 83), with advanced thrombosis observed in 21% of cases. Obesity emerged as the only independent factor significantly associated with the presence of PVT (p = 0.001, OR 2.619, 95% CI 1.577-4.352). Patients with PVT were more frequently excluded from the waiting list due to clinical contraindications compared to those without PVT (26% vs. 14%, p = 0.04). However, multivariable analysis did not demonstrate an independent association between PVT and access to the waiting list or LT. No significant differences were observed in the reasons for dropout from the waiting list between patients with and without PVT. Conclusions: PVT appears to be associated with the metabolic profile of LT candidates, particularly obesity; however, it does not significantly limit access to LT.