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Risk Factors for Intracardiac Thrombus During Liver Transplantation.

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Intracardiac thrombus (ICT) during liver transplants is a serious complication. Prophylactic intravenous heparin before vena cava clamping may reduce ICT risk in orthotopic liver transplantation (OLT) patients.

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Area of Science:

  • Cardiology
  • Hepatology
  • Transplantation Surgery

Background:

  • Intracardiac thrombus (ICT) is a life-threatening intraoperative complication during orthotopic liver transplantation (OLT).
  • End-stage liver disease impairs coagulation, increasing thrombus formation risk during OLT.
  • Identifying patients at high risk for ICT is crucial for prevention.

Purpose of the Study:

  • To identify risk factors associated with intracardiac thrombus (ICT) during orthotopic liver transplantation (OLT).
  • To evaluate the incidence and mortality of ICT in OLT patients.
  • To assess the potential protective effect of intravenous heparin administration.

Main Methods:

  • Retrospective cohort study of 528 orthotopic liver transplantation (OLT) patients from 2010 to 2017.
  • Analysis included bivariate tests and logistic regression to identify risk factors for intracardiac thrombus (ICT).
  • Comparison of outcomes between patients who received intravenous heparin before inferior vena cava clamping and those who did not.

Main Results:

  • The incidence of intracardiac thrombus (ICT) during OLT was 4.2%, with a 45.5% mortality rate.
  • Higher Model for End-Stage Liver Disease scores, increased donor BMI, and longer warm ischemia times were associated with ICT.
  • Administration of intravenous heparin prior to inferior vena cava clamping significantly reduced the odds of developing ICT (OR, 0.25; P = 0.01).

Conclusions:

  • The incidence of ICT in OLT is higher than previously reported, potentially due to routine transesophageal echocardiography use.
  • While some ICT risk factors are nonmodifiable, intravenous heparin administration before inferior vena cava clamping is a modifiable protective factor.
  • Further research is needed to confirm these findings and develop strategies for preventing ICT during OLT.