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Perioperative thrombotic complications associated with pediatric liver transplantation: a UNOS database evaluation

Dmitri Bezinover1, Molly F Deacutis1, Priti G Dalal1

  • 1Departments of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, USA.

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
|September 30, 2018
PubMed

Insights

Pediatric liver transplant patients, especially those under 5, face higher risks of portal vein thromboses (PVT) and graft failure. Preoperative PVT increases the likelihood of postoperative complications, suggesting a need for antithrombotic therapy.

Area of Science:

  • Hepatology
  • Pediatric Surgery
  • Transplantation Medicine

Background:

  • Portal vein thrombosis (PVT) is a significant concern in pediatric liver transplantation (LT).
  • Understanding the prevalence and risk factors for pre- and postoperative thromboses is crucial for improving outcomes.

Purpose of the Study:

  • To evaluate the prevalence of preoperative PVT and postoperative thromboses in pediatric LT recipients.
  • To identify factors associated with these thrombotic events and graft failure.

Main Methods:

  • Retrospective analysis of the UNOS database for pediatric LT cases between 2000 and 2015.
  • Patients were stratified into three age groups: 0-5, 6-11, and 12-18 years.
  • Statistical analysis to determine factors predictive of thromboses.

Main Results:

  • Out of 8982 pediatric LT, 4.3% had preoperative PVT and 4.4% had postoperative thromboses.
  • Younger age groups (0-5 and 6-11 years) showed a higher prevalence of both types of thromboses compared to older children (12-18 years).
  • Preoperative PVT independently predicted postoperative thromboses (OR=1.7), and younger children (<5 years) had increased odds of postoperative thromboses leading to graft failure (OR=2.9).

Conclusions:

  • Younger pediatric liver transplant recipients are more susceptible to thrombotic complications.
  • Preoperative PVT is a significant risk factor for postoperative thromboses.
  • Consideration of perioperative antithrombotic therapy is recommended for pediatric LT patients.
Abstract

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