Post-operative heparin reduces early venous thrombotic complications after orthotopic paediatric liver...

Area of Science:

• Hepatology
• Transplantation Surgery
• Vascular Surgery

Background:

• Thrombotic complications are a leading cause of graft failure and re-transplantation in pediatric liver transplant recipients.
• Current prevention strategies for thrombosis lack standardization, highlighting a critical unmet need in post-transplant care.

Purpose of the Study:

• To evaluate the efficacy of early postoperative intravenous unfractionated heparin in preventing thrombotic complications following pediatric liver transplantation.
• To compare the incidence of early venous thrombosis (VT) before and after the implementation of a standardized heparin prophylaxis protocol.

Main Methods:

• Retrospective analysis of 479 pediatric liver transplant cases from 2002 to 2016.
• Comparison of VT incidence between patients who received early heparin (10 UI/kg/hr starting 12 hours postoperatively) and those who did not.
• Multivariate analysis to identify risk factors for VT, including heparin use and patient age.

Main Results:

• A significantly lower incidence of venous thrombosis was observed in the heparin group (2.5%) compared to the non-heparin group (7.9%) (p=0.038).
• Heparin prophylaxis was independently associated with a reduced risk of VT (HR=0.29; p=0.045).
• Younger age (<1 year) was identified as an independent risk factor for VT (HR=2.62; p=0.028).

Conclusions:

• Early postoperative heparin administration is a safe and effective strategy for preventing early venous thrombosis after pediatric liver transplantation.
• This approach did not lead to a significant increase in bleeding complications.
• Further randomized controlled trials are warranted to confirm these findings and establish heparin prophylaxis as a standard of care.