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. 2023 Nov:12:100185.
doi: 10.1016/j.liver.2023.100185. Epub 2023 Oct 19.

Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?

Mercedes Martinez  1 , Elise Kang  1 , Fernando Beltramo  2 , Michael Nares  3 , Asumthia Jeyapalan  3 , Alicia Alcamo  4 , Alexandra Monde  5 , Leslie Ridall  6 , Sameer Kamath  7 , Kristina Betters  8 , Courtney Rowan  9 , Richard Shane Mangus  10 , Shubhi Kaushik  11   12 , Matt Zinter  13 , Joseph Resch  14 , Danielle Maue  9
Affiliations

Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?

Mercedes Martinez et al. J Liver Transpl. 2023 Nov.

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.

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

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Conflict of interest statement

Declaration of Competing Interest Dr. Zinter’s institution received funding from the National Heart, Lung, and Blood Institute (NHLBI) (K23HL146936). Drs. Zinter and Rowan received support for article research from the National Institutes of Health (NIH). Dr. Mangus received funding from F. Kohler-Chemie. Dr. Rowan’s institution received funding from the NHLBI K23; she received funding from the NIH (K23HL150244). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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