Introduction: Discrimination between benign(b-PVT) and malignant (m-PVT) portal vein thrombosis is crucial in HCC patients before LDLT.
Patients and methods: A total of 531 cases had LDLT between (Jan 2016–Dec 2022); 130 (25%) paediatrics and 391 (75%) adults. The presented HCC was in 122 (32%) of the transplanted adults cohort. We subdivided the adult cohort into 4 subgroups: HCC 84 (22%), HCC with PVT 38 (10%), PVT 50 (13%) and non-HCC/non-PVT 210 (55%). The aim was to assess the overall survival outcomes, disease free survival, HCC recurrence rate for HCC patients with or without (b-PVT) compared to non HCC cohorts. But segmental or main branch portal vein thrombosis (m-PVT) is accepted after successful tumor down-staging by TARE with or without sorafenib. 
Results: The 1y, 3yr and 5yrs post liver transplantation survival of HCC patients was similar to the non HCC cohort, 94%, 90%, 84% and 88%, 84%, 81% respectively (P=0.49) as in figure-1. While the 1y, 3yr and 5yrs survival time of HCC cohort has trends for better survival compared to HCC+PVT patients; 94%, 90%, 84% and 88%, 83%, 78% respectively (P=0.16) as in figure-2. The HCC patients with portal vein thrombosis were further subdivided into (HCC+ b-PVT) in 33/38(87%) and (HCC+ m-PVT) in 5/38(13%). The HCC recurrence rate among (HCC-only), (HCC+ b-PVT), and (HCC+m-PVT) is 7/84(8.3%), 2/33(6%), and (1/5(20%), respectively p=0.69. In respect to the pre-LDLT HCC BCLC staging, we find that the HCC recurrence rate was 3/43(7%) BCLC-A, 7/37(18.5%) BCLC-B, 1/5(20%) BCLC-C and 2/37(5%) BCLC-D patients.
Conclusion: It seems that benign (bPVT) is a common risk factor among cirrhotic patients presented with HCC seeking for LDLT. Discrimination between benign or malignant PVT in HCC patients is crucial. The b-PVT had similar survival to the equivalent cohort, while m-PVT (after down staging) had shown comparable outcomes.