{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:48:36Z","timestamp":1761709716115,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T00:00:00Z","timestamp":1587340800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Portal vein thrombus (PVT) is a challenge in liver transplantation. How PVT develops in cirrhotic patients who already have coagulopathy is unclear. This study aimed to investigate possible contributing factors to PVT in cirrhotic patients. A total of 349 cirrhotic patients who waited liver transplantation were included in this study and 48 of them had PVT. For all the patients, the mean age was 53.5 \u00b1 9.0 year old, and 75.9% of the patients were male. There were 233 (66.8%) patients who had either hepatitis B or C. The mean Model For End-Stage Liver Disease (MELD) score was 16.4 \u00b1 7.5. Eighteen of 48 patients with PVT and 145 of 301 patients without PVT received liver transplantation. Multivariate analysis showed that low protein S level (hazard ratio = 2.46, p = 0.017) was the only independent risk factor for PVT development. Protein S deficiency also demonstrated prognostic value on short-term survival, not only for cirrhotic patients awaiting liver transplantation (69.9% versus 84.1% at 1 year survival, p = 0.012), but also for the patients having liver transplantation (70.4% versus 84.8% at 1 year survival, p = 0.047). In conclusion, protein S level was an independent risk factor for PVT development in decompensated cirrhotic patients, and protein S deficiency was also a prognostic factor for the patients waiting for liver transplantation.<\/jats:p>","DOI":"10.3390\/jcm9041181","type":"journal-article","created":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T05:48:52Z","timestamp":1587448132000},"page":"1181","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Protein S for Portal Vein Thrombosis in Cirrhotic Patients Waiting for Liver Transplantation"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8830-3679","authenticated-orcid":false,"given":"Hao-Chien","family":"Hung","sequence":"first","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin-Chiao","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Hsien","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Chao","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsung-Han","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen-Fang","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting-Jung","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong-Shiue","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun-Ming","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Chen","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.jhep.2009.06.009","article-title":"Portal vein thrombosis: A predictable milestone in cirrhosis?","volume":"51","author":"Valla","year":"2009","journal-title":"J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4254\/wjh.v6.i2.64","article-title":"Portal vein thrombosis in liver cirrhosis","volume":"6","author":"Kinjo","year":"2014","journal-title":"World J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/0016-5085(85)90327-0","article-title":"Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients","volume":"89","author":"Okuda","year":"1985","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1136\/gut.2004.042796","article-title":"Splanchnic vein thrombosis in candidates for liver transplantation: Usefulness of screening and anticoagulation","volume":"54","author":"Francoz","year":"2005","journal-title":"Gut"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1097\/00007890-200005150-00023","article-title":"Portal vein thrombosis in adults undergoing liver transplantation: Risk factors, screening, management, and outcome","volume":"69","author":"Yerdel","year":"2000","journal-title":"Transplantation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1136\/gut.46.4.534","article-title":"Deficiency of natural anticoagulant proteins C, S, and antithrombin in portal vein thrombosis: A secondary phenomenon?","volume":"46","author":"Fisher","year":"2000","journal-title":"Gut"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.thromres.2015.03.010","article-title":"Natural anticoagulants deficiency and the risk of venous thromboembolism: A meta-analysis of observational studies","volume":"135","author":"Ambrosino","year":"2015","journal-title":"Thromb. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1136\/gut.2004.048181","article-title":"Infection, coagulation, and variceal bleeding in cirrhosis","volume":"54","author":"Thalheimer","year":"2005","journal-title":"Gut"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.jhep.2004.01.001","article-title":"Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis","volume":"40","author":"Amitrano","year":"2004","journal-title":"J. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1097\/00042737-200507000-00009","article-title":"Causes of portal venous thrombosis in cirrhotic patients: The role of genetic and acquired factors","volume":"17","author":"Mangia","year":"2005","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1002\/hep.1840160515","article-title":"The incidence of portal vein thrombosis at liver transplantation","volume":"16","author":"Nonami","year":"1992","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1053\/j.tcam.2012.07.003","article-title":"Endogenous anticoagulants","volume":"27","author":"Kubier","year":"2012","journal-title":"Top Companion Anim. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/jhep.2001.22172","article-title":"A model to predict survival in patients with end-stage liver disease","volume":"33","author":"Kamath","year":"2001","journal-title":"Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo Classification of Surgical Complications","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1056\/NEJM199603143341104","article-title":"Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis","volume":"334","author":"Mazzaferro","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1053\/jhep.2001.24563","article-title":"Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival","volume":"33","author":"Yao","year":"2001","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1111\/j.1440-1746.2011.07040.x","article-title":"Prevalence of the JAK2V617F mutation in Chinese patients with Budd-Chiari syndrome and portal vein thrombosis: A prospective study","volume":"27","author":"Qi","year":"2012","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1055\/s-0036-1597770","article-title":"Hemostasis in Acute and Chronic Liver Disease","volume":"37","author":"Tripodi","year":"2017","journal-title":"Semin. Liver Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.thromres.2012.11.003","article-title":"Coagulation imbalance may not contribute to the development of portal vein thrombosis in patients with cirrhosis","volume":"131","author":"Chen","year":"2013","journal-title":"Thromb. Res."},{"key":"ref_20","first-page":"e26407","article-title":"Risk Factors for Portal Vein Thrombosis in Patients With Cirrhosis Awaiting Liver Transplantation in Shiraz, Iran","volume":"15","author":"Homayon","year":"2015","journal-title":"Hepat. Mon."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1053\/j.gastro.2009.08.045","article-title":"An Imbalance of Pro- vs Anti-Coagulation Factors in Plasma from Patients with Cirrhosis","volume":"137","author":"Tripodi","year":"2009","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/MAJ.0b013e31826485fc","article-title":"Effect of antithrombin, protein C and protein S on portal vein thrombosis in liver cirrhosis: A meta-analysis","volume":"346","author":"Qi","year":"2013","journal-title":"Am. J. Med. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1177\/0300060513483413","article-title":"Value of D-dimer and protein S for diagnosis of portal vein thrombosis in patients with liver cirrhosis","volume":"41","author":"Zhang","year":"2013","journal-title":"J. Int. Med. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/00000658-200202000-00019","article-title":"Thrombendvenectomy for Organized Portal Vein Thrombosis at the Time of Liver Transplantation","volume":"235","author":"Molmenti","year":"2002","journal-title":"Ann. Surg."},{"key":"ref_25","first-page":"66","article-title":"Portal vein grafts in hepatic transplantation","volume":"161","author":"Shaw","year":"1985","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6769","DOI":"10.3748\/wjg.v21.i22.6769","article-title":"Portal vein thrombosis in cirrhosis: Controversies and latest developments","volume":"21","author":"Harding","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1080\/13651820701599033","article-title":"Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome","volume":"9","author":"Lendoire","year":"2007","journal-title":"HPB"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1111\/tri.13353","article-title":"Mortality in liver transplant recipients with portal vein thrombosis\u2014An updated meta-analysis","volume":"31","author":"Zanetto","year":"2018","journal-title":"Transpl. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/01.SLA.0000055277.78876.B7","article-title":"Modulation of Portal Graft Inflow: A Necessity in Adult Living-Donor Liver Transplantation?","volume":"237","author":"Troisi","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/S0041-1345(00)02496-9","article-title":"Excessive portal venous inflow as a cause of allograft dysfunction in small-for-size living donor liver transplantation","volume":"33","author":"Shimamura","year":"2001","journal-title":"Transplant. Proc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/S0168-8278(97)80292-9","article-title":"Protein C, protein S and antithrombin III in children with portal vein obstruction","volume":"27","author":"Dubuisson","year":"1997","journal-title":"J. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1002\/lt.20096","article-title":"Liver regeneration after adult living donor and deceased donor split-liver transplants","volume":"10","author":"Humar","year":"2004","journal-title":"Liver Transplant."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1097\/00001721-200110000-00005","article-title":"Tissue factor and thrombomodulin levels are correlated with stage of cirrhosis in patients with liver disease","volume":"12","author":"Tacke","year":"2001","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1001\/archinte.161.20.2433","article-title":"Hypercoagulability syndromes","volume":"161","author":"Thomas","year":"2001","journal-title":"Arch. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.5858\/2002-126-1349-AROTTD","article-title":"A review of the technical, diagnostic, and epidemiologic considerations for protein S assays","volume":"126","author":"Goodwin","year":"2002","journal-title":"Arch. Pathol. Lab Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3931","DOI":"10.1016\/j.transproceed.2008.10.104","article-title":"Resolution of Preoperative Portal Vein Thrombosis After Administration of Antithrombin III in Living Donor Liver Transplantation: Case Report","volume":"41","author":"Imai","year":"2009","journal-title":"Transplant. Proc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1756284818793561","DOI":"10.1177\/1756284818793561","article-title":"Anticoagulant therapy in patients with liver cirrhosis and portal vein thrombosis: Insights for the clinician","volume":"11","author":"Basili","year":"2018","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/bjh.12107","article-title":"British Committee for Standards in H. Guideline on the management of bleeding in patients on antithrombotic agents","volume":"160","author":"Makris","year":"2013","journal-title":"Br. J. Haematol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/1181\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:09:06Z","timestamp":1760364546000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/1181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,20]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["jcm9041181"],"URL":"https:\/\/doi.org\/10.3390\/jcm9041181","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2020,4,20]]}}}