Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

Abstract

Background: Vascular complications, such as HAT, are an important cause of graft loss and recipient mortality. We aimed to characterize post-transplant thrombotic events in a cohort of liver transplant recipients, and identify independent risk factors for these complications.

Methods: We conducted a thrombophilic study of 293 orthotopic liver transplants performed in the Digestive Surgery Department of the 12 de Octubre Hospital (Madrid, Spain) between January 2001 and December 2006.

Results: The most frequent post-transplant thrombotic events were HAT (9%) and PVT (1.7%). The one variable associated with post-transplant thrombotic event was a high fibrinogen level in the global cohort of liver transplantation. But toxicity as event post-OLT has been associated with post-transplant thrombotic event in the retrospective group and high fibrinogen level and low protein C levels were associated post-transplant thrombotic event in the prospective group. Liver disease relapse (HR 6.609, p < 0.001), high levels of FVIII (HR 1.008, p = 0.019)) and low levels of antithrombin (HR 0.946, p < 0.001) were associated with poor overall survival (OS).In conclusion, high fibrinogen and decreased protein C levels were associated with allograft thrombosis. Further studies are required in order to assess the clinical relevance of these parameters in prospective studies and to study the effect of anticoagulation prophylaxis in this group of risk.

Figure 1

Liver transplant recipient overall survival (OS). A. Post-transplant thrombosis was associated with a poor outcome (P < 0.03). B. High FVIII:C levels were associated with a poor outcome: the median OS was 69.6 and 132.1 months in groups with high and low FVIII:C, respectively (P < 0.003). Median follow-up was 21.7 months (range 1-184.6 months).

Figure 2

High FVIII:C levels and Recipient Overall Survival. High FVIII:C levels were associated with a poor outcome separately in both young and elderly groups (Log Rank 8.56; p = 0.0034).