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Portal vein thrombosis (PVT) is a significant complication during both the pre-transplant and postoperative periods of liver transplantation. The multifactorial etiology of PVT, the paradoxical hemostatic state in liver cirrhosis and the limited usefulness of standard coagulation tests highlight the necessity of formalized models to assess thrombosis risk.

Objective: Using a mathematical model of the blood coagulation system, investigate the influence of hemodynamic conditions and coagulation factor levels on the likelihood of thrombus formation in the portal vein.

The portal vein is modelled as a flow-through reactor with rapid convective mixing. The mathematical model is based on Panteleev et al. (2010) detailed kinetic scheme, incorporating equations for the extrinsic pathway of coagulation activation, positive and negative feedback loops, and inhibition of active factors. The resulting system of ordinary differential equations was integrated using a one-stage Rosenbrock method with complex coefficients.

Thrombin generation was shown to exhibit threshold dependence on blood flow velocity. Above a critical velocity, the initiation phase does not transition to the amplification phase. This corresponds to physiological conditions that prevent thrombus formation. We demonstrated that, at reduced fibrinogen concentrations characteristic of hepatic dysfunction, the critical velocity threshold above which thrombus formation is suppressed increases. This indicates the system’s heightened susceptibility to stasis. Protein C deficiency had minimal effect on thrombogenesis dynamics under the modeled conditions. The modeling results qualitatively agree with clinical data on fibrinogen distribution in PVT patients ($n$ = 932, Sklifosovsky Research Institute).

A mathematical model of fluid movement in the portal vein is considered. The fundamental circumstance determining the whole variety of portal hemodynamic phenomena is the absence of a valve apparatus. The flow direction is solely a function of the pressure gradient, and, therefore, it is fundamentally reversible when the boundary conditions of the system change.

Calculations were performed in the area representing a CT image fragment of the portal vein of a particular patient, which does not contain vascular bifurcations. The interpolation of patient Dopplerography data published in the press was used as boundary conditions for the flow. The calculations were carried out using the FlowVision industrial hydrodynamics software package. A comparison of calculations using the ideal fluid model and the Kuemada model of viscoplastic flow is carried out.

Calculations were performed for different values of the resistance coefficient corresponding to the physiological norm and with an increased value of the resistance coefficient.

At a normal value of the resistance coefficient, the flow in the portal vein is characterized by strong convective mixing.

As a result of calculations, it was found that when using the Kuemada model, the flow in the portal vein is stratified. The nature of the stratification depends on the hematocrit. At a normal value of the resistance coefficient, a plastic core of the flow is formed as the velocity decreases. With an increased value of the resistance coefficient during flow inversion, the flow core is also formed. When the flow is inverted, the plastic core continues to move in the forward direction, while the wall layers of the liquid begin to move in the opposite direction.

It is noted that in order to obtain correct modeling results, it is necessary to refine the blood composition of the portal vein and, possibly, refine the rheological model. Such information can be obtained both from comparing simulation data with clinical data, and by laboratory examination of portal vein blood.