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Prevention of hepatic artery thrombosis in pediatric liver transplantation
Y Hashikura1, S Kawasaki, N Okumura
1First Department of Surgery, Shinshu University School of Medicine, Japan.
Insights
Intensive anticoagulation therapy effectively prevented hepatic artery thrombosis in pediatric liver transplant recipients. This approach, focusing on early correction of coagulation imbalances, offers a promising model for preventing this serious complication in children.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Hepatic artery thrombosis (HAT) is a critical complication following orthotopic liver transplantation (OLT), particularly in pediatric patients.
- Children face increased HAT risk due to smaller hepatic artery diameters and a postoperative hypercoagulable state.
Purpose of the Study:
- To evaluate the efficacy of an intensive anticoagulant therapy regimen in preventing HAT in pediatric living-related liver transplant recipients.
- To assess the impact of this therapy on coagulation and fibrinolytic systems post-transplantation.
Main Methods:
- A cohort of 24 pediatric patients (5 months–15 years) undergoing liver transplantation received intensive anticoagulation.
- Therapy included low-molecular-weight heparin, antithrombin III concentrates, prostaglandin E1, fresh frozen plasma, and a protease inhibitor.
- Coagulation and fibrinolytic parameters were monitored, including thrombin-antithrombin III complex, antithrombin III, plasmin-alpha 2 plasmin inhibitor complex, D-dimer, t-PA, and PAI-1.
Main Results:
- No cases of hepatic artery thrombosis were observed in any of the 24 pediatric recipients.
- Coagulation system acceleration and delayed fibrinolytic system recovery were noted in the early postoperative period.
- Antithrombin III activity was successfully maintained within the normal range through concentrate administration.
Conclusions:
- The intensive anticoagulant regimen, emphasizing early correction of coagulation system imbalances, proved highly effective in preventing HAT in pediatric liver transplant patients.
- This therapeutic strategy may serve as a valuable model for preventing HAT in this high-risk population.
Abstract:
Hepatic artery thrombosis after orthotopic liver transplantation is a serious complication, especially in children. We report our experience with intensive anticoagulant therapy during and after living-related liver transplantation in pediatric recipients. Twenty-four patients between 5 months and 15 years of age were studied. The mean diameter of the anastomosed hepatic arteries was 2.7 mm. The anticoagulant therapy consisted of low-molecular-weight heparin, antithrombin III concentrates, prostaglandin E1, fresh frozen plasma, and a protease inhibitor. The profiles of the coagulation and fibrinolytic systems were monitored by measuring several parameters, including plasma levels of thrombin-antithrombin III complex, antithrombin III, plasmin-alpha 2 plasmin inhibitor complex, fibrin degradation product D-dimer, tissue type-plasminogen activator, and plasminogen activator inhibitor-1. Acceleration of the coagulation system and delayed recovery of the fibrinolytic system were observed during the early postoperative days. The plasma level of antithrombin III activity was maintained within the normal range by the administration of antithrombin III concentrates. None of the recipients developed hepatic artery thrombosis. Children have been reported to be at a greater risk of developing hepatic artery thrombosis than adults due to the small diameters of their hepatic arteries and the postoperative hypercoagulable state. We believe that the intensive anticoagulation therapy described in this study, the main concept of which is the early correction of imbalance between the coagulant and anticoagulant systems, could become a model for the prevention of hepatic artery thrombosis in pediatric liver transplantation patients.