S2403 The Impact of Cavernous Transformation on Survival in Patients With Portal Vein Thrombosis

Introduction: Splanchnic vein thrombosis (SVT) can lead to complications including portal hypertension and hepatic dysfunction. Some evidence suggests development of cavernous transformation of the portal vein (CTPV) is a compensatory mechanism for chronic SVT, but more data are needed to clarify prognosis and best management in patients with this condition. The purpose of this study was to compare risk of death among those patients having CTPV versus those without, providing insight into prognostic significance. Methods: We queried an EMR at a large quaternary care hospital for imaging studies with reported SVT. The initial search identified 1889 patients with suspected SVT on CT reports from 2008 to 2023 by searching for terms related to SVT. We recorded if patients demonstrated CTPV on initial imaging or developed it on follow up. Using an Extended Cox Proportional Hazards Model, we evaluated the association between CTPV and death or hospice admission (used as a proxy for death) while controlling for other potential risk factors, including sex, age, cirrhosis, and malignancy. Results: Of the 1,184 patients with confirmed SVT, 302 (25.6%) had CTPV on initial imaging, and an additional 129 (10.9%) developed it on follow up. Patients with cirrhosis accounted for 485 (41.0%) patients with SVT and 192 (39.6%) of those had CTPV. Age at SVT diagnosis showed a statistically significant association with survival (hazard ratio [HR] = 1.03, 95% CI: [1.02, 1.04], P < 0.001), with each additional year of age increasing risk of death by approximately 3.1%. CTPV was not found to be significantly associated with risk of death in the general SVT cohort (HR = 0.90, 95% CI: [0.74, 1.09]); however, among patients without cirrhosis, CTPV showed a non-significant protective trend (HR = 0.77, 95% CI: [0.57, 1.05]). Most notably, among patients with cirrhosis, multivariable analysis conversely revealed a significant increase in risk of death (HR = 1.77, 95% CI: [1.37, 2.30]) in patients with CTPV. Conclusion: We describe rates of CTPV and mortality in one of the largest retrospective studies of SVT to date. While previous studies have suggested improved prognosis for patients who develop CTPV, our study suggests CTPV was associated with a significantly increased risk of death, specifically in patients with cirrhosis. Future research is needed to investigate the mechanisms by which CTPV influences survival in different populations and explore likely contributing factors including treatment differences or comorbidities in patients who develop CTPV.