Nonselective beta-blocker therapy: a potential risk factor for posthepatectomy portal vein thrombosis in cirrhotic patients

Background: Posthepatectomy portal vein thrombosis (PH-PVT) is a rare but serious complication after liver resection, especially in cirrhotic patients. Nonselective beta-blockers (NSBBs), commonly used to manage portal hypertension, may increase PH-PVT risk due to their hemodynamic effects.

Methods: A retrospective cohort study was conducted in cirrhotic patients undergoing elective liver resection between April 2018 and October 2024. Patients were grouped based on preoperative NSBB use. Clinical and operative data were analyzed to identify risk factors for PH-PVT, with the primary outcome being the incidence of PH-PVT within 90 days postoperatively.

Results: Among 84 patients included, 14 (17%) received NSBB therapy. PH-PVT occurred in 9% of the total cohort, with a remarkably higher incidence in the NSBB group (50%) compared to the non-NSBB group (1%, p<0.01). Multivariate analysis identified NSBB use (odds ratio [OR]: 45.23; 95% CI: 5.74–1005.62; p=0.002), prolonged operative time (OR: 1.01; 95% CI: 1.00–1.01; p=0.041), and extended Pringle maneuver duration (OR: 1.07; 95% CI: 1.02–1.21; p=0.007) as independent risk factors for PH-PVT. While postoperative complications were significantly higher in the NSBB group compared to the non-NSBB group (78% vs. 41%, p=0.02), the risk of Esophageal variceal bleeding was rare and occurred at comparable rates in both groups (NSBB: 0%, non-NSBB: 1%, p=0.65).

Conclusion: NSBBs significantly increase the risk of PH-PVT in cirrhotic patients undergoing liver resection. Although NSBBs are effective in preventing variceal bleeding, their perioperative use requires caution due to the heightened thrombotic risk. Tailored risk stratification and individualized therapeutic strategies are essential to mitigate this risk while maintaining the benefits of NSBB therapy.

Publikationsverlauf

Artikel online veröffentlicht:
04. September 2025