Vascular thrombosis after pediatric liver transplantation: Is prevention achievable? - 26/10/23

Doi : 10.1016/j.liver.2023.100185

Mercedes Martinez ^a,^{^{1
These authors are equal contributors to this work and are co-first authors.},}^⁎ , Elise Kang ^a,^{^{1
These authors are equal contributors to this work and are co-first authors.}}, Fernando Beltramo ^b, Michael Nares ^c, Asumthia Jeyapalan ^c, Alicia Alcamo ^d, Alexandra Monde ^e, Leslie Ridall ^f, Sameer Kamath ^g, Kristina Betters ^h, Courtney Rowan ⁱ, Richard Shane Mangus ^j, Shubhi Kaushik ^k,ⁿ, Matt Zinter ^l, Joseph Resch ^m, Danielle Maue ⁱ
^a Columbia University Irving Medical Center, Department of Pediatrics, New York, USA
^b Children's Hospital of Los Angeles, Department of Anesthesiology Critical Care, Los Angeles, USA
^c University of Miami Miller School of Medicine, Department of Pediatrics, Miami, USA
^d Children's Hospital of Philadelphia, Department of Critical Care Medicine, Philadelphia, USA
^e Georgetown University Hospital, Department of Pediatrics, Washington DC, USA
^f University of Colorado School of Medicine, Department of Pediatrics, Aurora, USA
^g Duke University, Department of Pediatrics, Durham, USA
^h Vanderbilt University, Department of Pediatrics, Nashville, USA
ⁱ Indiana University School of Medicine, Department of Pediatrics, Indianapolis, USA
^j Indiana University School of Medicine, Department of Surgery, Indianapolis, USA
^k Mount Sinai School of Medicine, Department of Pediatrics, New York, USA
^l University of California San Francisco, Department of Pediatrics, San Francisco, USA
^m University of Minnesota, Department of Pediatrics, Minneapolis, USA
ⁿ Children’s Hospital at Montefiore, New York, USA

^⁎Corresponding author.

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Abstract

Background

Vascular thromboses (VT) are life-threatening events after pediatric liver transplantation (LT). Single-center studies have identified risk factors for intra-abdominal VT, but large-scale pediatric studies are lacking.

Methods

This multicenter retrospective cohort study of isolated pediatric LT recipients assessed pre- and perioperative variables to determine VT risk factors and anticoagulation-associated bleeding complications.

Results

Within seven postoperative days, 31/331 (9.37%) patients developed intra-abdominal VT. Open fascia occurred more commonly in patients with VT (51.61 vs 23.33%) and remained the only independent risk factor in multivariable analysis (OR = 2.84, p = 0.012). Patients with VT received more blood products (83.87 vs 50.00%), had significantly higher rates of graft loss (22.58 vs 1.33%), infection (50.00 vs 20.60%), and unplanned return to the operating room (70.97 vs 16.44%) compared to those without VT. The risk of bleeding was similar (p = 0.2) between patients on and off anticoagulation.

Conclusions

Prophylactic anticoagulation did not increase bleeding complications in this cohort. The only independent factor associated with VT was open fascia, likely a graft/recipient size mismatch surrogate, supporting the need to improve surgical techniques to prevent VT that may not be modifiable with anticoagulation.

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Keywords : Pediatric liver transplantation, Vascular complications, Hepatic artery thrombosis, Portal vein thrombosis

Plan

Introduction

Methods

Subject variables and outcomes

Statistical analysis

Ethical considerations

Results

Patient characteristics, critical care utilization and vascular complications

Risk factors for vascular complication

Vascular thrombosis and postoperative complications

Discussion

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Vol 12

Article 100185- novembre 2023 Retour au numéro

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Vascular thrombosis after pediatric liver transplantation: Is prevention achievable? - 26/10/23

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Conclusions

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