Portal vein thrombosis: A predictable milestone in cirrhosis?

Development of portal vein thrombosis (PVT) is a significant milestone in the natural history of cirrhosis. It is associated with worsening liver function, ascites, and the occurrence of gastroesophageal variceal bleeding. However, previous studies have been cross-sectional in design, and therefore have not been able to address whether this association is causal (i.e. PVT actually causes decompensation) or whether the development of PVT is only a further consequence of advanced liver disease. On the other hand, it is clear that PVT increases morbidity and mortality associated with liver transplant and may even contraindicate it [1,2].