Background portal vein thrombosis (PVT) is the most common thrombotic event in liver transplant (LT) recipients, but its impact on mortality after LT has been analyzed in heterogeneous cohorts with mixed results. Aim to conduct a meta‐analysis on the impact of PVT on post‐LT survival. Methods a systematic search was conducted on studies (published from January 1986 to January 2018) that reported 30‐day and 1‐year mortality after LT of PVT patients. Results 427 articles were reviewed and 44 were included. Among 98,558 LT, 7,257 (7.3%) involved patients with PVT. The mean quality was high (7.1 on the Newcastle‐Ottawa scale). The 30‐day pooled mortality rate was higher for patients with PVT (64/490; 13%) than for others (259/3,357; 7%) (OR 2.29; 95%CI 1.43‐3.68; p<0.0001). One‐year mortality was likewise higher in recipients with (853/6,302; 13.5%) than in those without PVT (7,476/75,355; 9.9%) (OR 1.38; 95%CI 1.14‐1.66; p<0.0001). Heterogeneity wasn't significant (I² 46% and 65%). Patients whose PVT was complete had a higher 30‐day pooled mortality rate (OR 5.65; 95%CI 2‐15.96; p<0.0001), and one‐year mortality rate (OR 2.48; 95%CI 0.99‐6.17; p=0.38) than patients with partial PVT. Conclusion PVT is common in LT candidates and it's associated with higher short‐ and medium‐term mortality after LT.

Sarcopenia and myosteatosis are common in patients with cirrhosis. This study aimed to determine the prevalence of these muscle changes, their interrelations and their prognostic impact over a 12-month period. We conducted a prospective multicentre study involving 433 patients. Sarcopenia and myosteatosis were evaluated using computed tomography scans. The 1-year cumulative incidence of relevant events was assessed by competing risk analysis. We used a Fine-Gray model adjusted for known prognostic factors, to evaluate the impact of sarcopenia and myosteatosis on mortality, hospitalization, and liver decompensation. At enrolment, 166 patients presented with isolated myosteatosis, 36 with isolated sarcopenia, 135 with combined sarcopenia and myosteatosis and 96 patients showed no muscle changes. The 1-year cumulative incidence of death in patients with either sarcopenia and myosteatosis (13.8%) or isolated myosteatosis (13.4%) was over twice that of patients without muscle changes (5.2%) or with isolated sarcopenia (5.6%). The adjusted subhazard ratio for death in patients with muscle changes was 1.36 (95% CI 0.99, 1.86) (P=0.058). The cumulative incidence of hospitalization was significantly higher in patients with combined sarcopenia and myosteatosis than in patients without muscle changes (adjusted subhazard ratio 1.18, 95% CI 1.04 to 1.35). The cumulative incidence of liver decompensation was greater in patients with combined sarcopenia and myosteatosis (p=0.018) and those with isolated sarcopenia (p=0.046) than in patients without muscle changes. Lastly, we found a strong correlation between function tests and frailty scores with the presence of muscle changes. Myosteatosis, whether alone or combined with sarcopenia, is highly prevalent in patients with cirrhosis and is associated with significantly worse outcomes. The prognostic role of sarcopenia should always be evaluated in relation to the presence of myosteatosis. This study investigates the prognostic role of muscle changes in patients with liver cirrhosis. The novelty of this study is the multicentre, prospective nature and the distinguishing impact of individual muscle changes and their combination on prognosis in cirrhosis. This study highlights the prognostic role of myosteatosis, especially when combined with sarcopenia. On the other hand, the relevance of sarcopenia could be mitigated when considered together with myosteatosis. The implication from these findings is that sarcopenia should never be evaluated individually and that myosteatosis may have a dominant role in the prognosis of patients with liver cirrhosis.