Intracardiac thrombosis during liver transplant: A 17-year single-institution study

Area of Science:

• Cardiology
• Hepatology
• Transplantation Medicine

Background:

• Intracardiac thrombosis (ICT) is an uncommon yet severe complication during orthotopic liver transplantation (OLT).
• High mortality rates associated with ICT necessitate identifying predisposing factors and improving detection methods.

Purpose of the Study:

• To retrospectively identify potential predisposing factors for ICT in patients undergoing OLT.
• To analyze intraoperative hemodynamic, coagulation, and thromboelastography (TEG) data in relation to ICT occurrence.

Main Methods:

• Retrospective review of 2750 OLT cases from 1998 to 2014.
• Analysis of intraoperative hemodynamic parameters, coagulation values, and TEG data for 10 patients with ICT.
• Review of patient history for predisposing conditions such as venous thrombosis and atrial fibrillation.

Main Results:

• Preexisting venous thrombosis, atrial fibrillation, and transjugular intrahepatic portosystemic shunt placement were associated with ICT.
• High Model for End-Stage Liver Disease (MELD) score, low cardiac output, and sepsis were not linked to ICT.
• Patients with ICT in both right and left heart chambers had 100% mortality, while those with only right-sided thrombi survived.

Conclusions:

• Certain patient factors, not standard coagulation tests or TEG, may predict ICT risk during OLT.
• Right-sided ICT appears to have a better prognosis than biventricular ICT, with potential for spontaneous resolution.
• Routine use of transesophageal echocardiography (TEE) is recommended for improved ICT detection during OLT.