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Introduction Portal hypertension (PHTN) secondary to chronic portomesenteric venous thrombosis (PMVT), presenting with and without cirrhosis and in varying states of decompensation, can be associated with high morbidity and mortality (1). Decision-making is often required to go beyond established guidelines. Our objective was to create a forum in which we could reach a consensus on timing of intervention and the type of treatment modality for a group of patients in whom surgical and interventional procedures have their own risk-benefit ratio (2). These ‘grey areas’ are best served by a multidisciplinary (MDM) meeting where treatment must be highly individualised. Our institute is uniquely placed to host an MDM consisting of expertise of multi-visceral and liver transplant surgeons and physicians, hepatologists, haematologists, and interventional radiologists. We share our experiences of implementing a complex PHTN MDM, which has received referrals from across the UK and Republic of Ireland.Methods Retrospective review to evaluate the implementation of the MDM at a single tertiary hepatology and transplant centre in the East of England. Demographic and clinical data were reviewed via electronic records and the MDM management outcomes.Results Between December 2022 and April 2025, 12 MDMs were held on a quarterly basis. Median number of patients discussed at each MDM was 9 (range of 6 to 12). A total of 88 patients were discussed, with a mean age of 54 years; non-cirrhotic 75% (n=66); chronic PMVT in 53.4% (n=47) and of these, 23.4% (n=11) were of the more severe Yerdel grade 4 classification. The main reason for referral was refractory portal hypertensive bleeding (28.4%). Others included refractory ascites (13.6%), pre-emptive review of imaging to establish a plan for worsening symptom burden/further decompensation (12.5%), consideration of TIPS pre-op (8%) and pressure/pain symptoms related to splenomegaly (6.8%). A total of 11 patients (12.5%) have undergone interventional or surgical modulation of portal hypertension. 30% of patients discussed were outside our regional referring area ( figure 1).Conclusion The MDM is now embedded in the care of the PHTN patient in East of England and we use this setting to evaluate severity of disease, consolidate which interventions are appropriate, and shared decision-making with contingency planning. Multi-visceral transplantation is reserved for patients in whom other treatment modalities have failed. Challenges ahead include formalisation of care networks via commissioning pathways and streamlining investigations to minimise time to decision-making.References Elkrief, et al. Portal Vein Thrombosis: diagnosis, management, and endpoints for future clinical studies. Lancet Gastroenterol Hepatol 2024.Ageno, et al. Portal vein thrombosis: state of the art review. J Clin Med 2024.Abstract 106 Figure 1Geographical distribution of PHTN MDM referrals according to patient postcode