Portal Hypertension after Liver Transplantation—Causes and Management

Abstract

Purpose of Review: While portal hypertension (PHT) treatment strategies for patients with advanced chronic liver disease (ACLD) are well established, studies on the management of PHT after orthotopic liver transplantation (OLT) are limited. This is due to the heterogeneous causes of portal hypertension in the OLT setting. Recent Findings: Specific recommendations for the management of non-alcoholic steatohepatitis (NASH), including medical and surgical therapeutic options, and hepatitis C virus (HCV) infection after OLT, are available with most of them applying to transplanted patients. Important concepts to prevent and manage portal vein thrombosis (PVT)—including anticoagulation and TIPS implantation—have been developed. Surgical approaches to resolve PVT, when encountered intraoperatively, have been refined. Finally, interventional treatment options for PHT-related complications and hepatic venous outflow obstruction are available. Summary: NASH has a high recurrence rate and causes considerable postoperative morbidity. HCV can be successfully treated in most cases. Specific medical and interventional as well as surgical treatment options are available for PHT after OLT—including for PHT due to surgical complications.