Reply to "Liver Transplantation for Porto-sinusoidal Vascular Liver Disorder: Long-term Outcome"

We thank Agrawal et al for their interest in our recent publication1 in the Transplantation journal; we agree with them that there are still many questions, much more than the ones pointed out in this letter, to be answered in relation to porto-sinusoidal vascular liver disorder (PSVD) and liver transplant (LT). However, we would like to emphasize that it is clearly stated in our article that the aim of our study was to identify features associated with post-LT outcome in, up to now, the largest group of PSVD patients, focusing on potential recurrence of the disease and post-LT survival.1 Therefore, answering the points mentioned by Agrawal et al was completely out of the scope of our article. Indeed, we are now evaluating the natural history of a large cohort of PSVD patients, trying to answer points raised by Agrawal et al, and also evaluating many other aspects of the disease. We completely agree with Agrawal et al about the relevance of one very important message of our work. There is a subgroup of PSVD patients who have quite high mortality despite LT, and in most of these cases, death is more related to the underlying associated disorder than to the liver disease itself. Therefore, when considering LT in this subgroup of PSVD patients, the potential risk and benefit of being transplanted must be discussed in an individualized way.