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Published on: November 7, 2020
Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?
Mercedes Martinez1, Elise Kang1, Fernando Beltramo2
1Columbia University Irving Medical Center, Department of Pediatrics, New York, USA.
Insights
Open fascia is the primary risk factor for vascular thromboses after pediatric liver transplants. Anticoagulation did not increase bleeding, suggesting improved surgical techniques are key to preventing these life-threatening events.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Vascular Surgery
Background:
- Vascular thromboses (VT) pose significant life-threatening risks in pediatric liver transplantation (LT).
- Existing research on intra-abdominal VT risk factors is limited to single-center studies, lacking large-scale pediatric data.
Purpose of the Study:
- To identify risk factors for intra-abdominal vascular thromboses (VT) in pediatric liver transplant recipients.
- To assess anticoagulation-associated bleeding complications in this patient population.
Main Methods:
- A multicenter retrospective cohort study was conducted.
- Pre- and perioperative variables were analyzed in isolated pediatric LT recipients.
Main Results:
- 9.37% of patients developed intra-abdominal VT within seven postoperative days.
- Open fascia was the sole independent risk factor for VT (OR = 2.84, p = 0.012).
- VT patients experienced higher rates of blood product transfusion, graft loss, infection, and reoperation; bleeding risk was similar with or without anticoagulation.
Conclusions:
- Prophylactic anticoagulation did not elevate bleeding complications in pediatric LT recipients.
- Open fascia, potentially indicating graft/recipient size mismatch, is the primary VT risk factor.
- Enhanced surgical techniques are crucial for preventing VT, as it may not be fully preventable with anticoagulation alone.
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.
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