Hepatic artery thrombosis and liver malignancy in pediatric liver transplantation
ABSTRACT Hepatic artery thrombosis (HAT) remains a significant cause of graft failure and mortality after pediatric liver transplantation. Conditions not associated with hepatic failure, such as liver tumors, may be more prone to thrombotic problems after transplant. We hypothesized that liver transplant for hepatic malignancies may be associated with increased rates of HAT in the posttransplant period.
We conducted a retrospective review of pediatric patients (age, 0-21 years) who underwent primary liver transplantation at a free-standing children's hospital from 1990 to 2009. We reviewed cause of underlying liver disease, age, sex, weight, occurrence of HAT, use of antiplatelets and anticoagulants perioperatively, as well as reintervention, retransplant, and death.
A total of 129 children underwent 146 liver transplants, and 15 (12%) patients developed HAT. Nine liver transplants were performed for hepatic malignancy, and 4 (44%) of these patients developed HAT (relative risk, 4.85; 95% confidence interval, 1.9-12.2; P = .0015). All 4 children with hepatic malignancy and HAT required reintervention, including 3 retransplants (75%). One of these patients died.
Hepatic artery thrombosis occurs approximately 5 times more often and appears to be more morbid in children with hepatic malignancy after transplantation. Prospective evaluation of prophylactic anticoagulation regimens in the setting of hepatic malignancy requiring transplantation is warranted.
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ABSTRACT: Background. Hepatic artery thrombosis (HAT) after liver transplantation (LT) increases patient morbidity and mortality. Early HAT is considered to occur within one month post LT, whilst late HAT is after one month. Few studies have addressed late HAT post LT especially in pediatric patients. Methods. Between 1987-2007, 99 patients (age <18 years) underwent deceased donor LT. Out of 66 eligible patients, 34 (52%) underwent magnetic resonance imaging (MRI) according to protocol. Based on MRI findings, patients were grouped according to those that did and did not experience late HAT. Additionally, potential risk factors for late HAT were analyzed retrospectively. P-values were adjusted for multiplicity. Results. Median age (interquartile range; IQR) at LT was 1.7 (1.0 - 9.6) and median (IQR) follow-up time at MRI was 9.5 (4.0 - 16.4) years. Late HAT was diagnosed in 15 of 34 (44%, 95% CI 29-61) patients with MRI, and in 3 of these with angiography preceding MRI. Ultrasonography (US) revealed late HAT in 6 of these 15, with a sensitivity of 40% (95% CI 20-64). Donor/recipient weight ratio remained significantly higher in late HAT patients compared to patients without late HAT, after adjusting p-values (5.4 vs. 1.9, p=0.03). No marked differences were observed in laboratory or liver histology parameters between groups. Conclusions. Late HAT is common after pediatric LT. Donor/recipient weight ratio was higher in late HAT patients which was attributable to smaller recipient weight. No salient features of late HAT were observed with respect to laboratory or histological parameters, at least in terms of our study's cross-sectional period. Liver Transpl , 2014. © 2014 AASLD.Liver Transplantation 05/2014; 20(5). DOI:10.1002/lt.23852 · 3.79 Impact Factor
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ABSTRACT: Postoperative thromboprophylactic anticoagulation against Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) is standard of care with current evidence-based guidelines. However, majority of liver transplant (LT) patients have thrombocytopenia and/or prolonged INR before surgery. Studies or guidelines regarding role of prophylactic anticoagulation after LT are lacking. There is a need to balance the risk of thrombosis with significant hemorrhage, implying those needing transfusion or return to OR due to bleeding. We conclude that after LT, anticoagulation is not required routinely for DVT/PE prophylaxis. Rather, it is indicated in specific circumstances, chiefly for prophylaxis of hepatic artery thrombosis or portal vein thrombosis in cases with use of grafts, pediatric cases, small size vessels, Budd Chiari syndrome, amongst others.Clinical and Applied Thrombosis/Hemostasis 06/2014; 20(7). DOI:10.1177/1076029614538490 · 1.58 Impact Factor