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Thromb Haemost 2020; 120(04): 627-637
DOI: 10.1055/s-0039-1701010
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Routine Postoperative Antithrombotic Therapy in Pediatric Liver Transplantation: Impact on Bleeding and Thrombotic Complications

Maureen J. M. Werner
1   Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
2   Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Ruben H. J. de Kleine
1   Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Marieke T. de Boer
1   Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Vincent E. de Meijer
1   Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
René Scheenstra
3   Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Henkjan J. Verkade
3   Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Frank A. J. A. Bodewes
3   Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Sander T. H. Bontemps
4   Department of Pediatric Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Koen M. E. M. Reyntjens
5   Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Riksta Dikkers
6   Department of Pediatric Radiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Ton Lisman
1   Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
2   Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Robert J. Porte
1   Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
2   Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
› Author Affiliations Funding None.
Further Information

Publication History

25 June 2019

04 December 2019

Publication Date:
29 January 2020 (online)

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Abstract

Background Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) are serious causes of morbidity and mortality after pediatric liver transplantation. To reduce thrombotic complications, routine antithrombotic therapy consisting of 1 week heparin followed by 3 months acetylsalicylic acid, was implemented in our pediatric liver transplant program in 2003. This study aimed to evaluate incidences of bleeding and thrombotic complications since the implementation of routine antithrombotic therapy and to identify risk factors for these complications.

Methods This retrospective cohort study includes 200 consecutive pediatric primary liver transplantations performed between 2003 and 2016. Uni- and multivariate logistic regression analysis, Kaplan–Meier method, and Cox regression analysis were used to evaluate recipient outcome.

Results HAT occurred in 15 (7.5%), PVT in 4 (2.0%), and venous outflow tract thrombosis in 2 (1.0%) recipients. Intraoperative vascular interventions (odds ratio [OR] 14.45 [95% confidence interval [CI] 3.75–55.67]), low recipient age (OR 0.81 [0.69–0.95]), and donor age (OR 0.96 [0.93–0.99]) were associated with posttransplant thrombosis. Clinically relevant bleeding occurred in 37%. Risk factors were high recipient age (OR 1.08 [1.02–1.15]), high Child–Pugh scores (OR 1.14 [1.02–1.28]), and intraoperative blood loss in mL/kg (OR 1.003 [1.001–1.006]). Both posttransplant thrombotic (hazard ratio [HR] 3.38 [1.36–8.45]; p = 0.009) and bleeding complications (HR 2.50 [1.19–5.24]; p = 0.015) significantly increased mortality.

Conclusion In 200 consecutive pediatric liver transplant recipients receiving routine postoperative antithrombotic therapy, we report low incidences of posttransplant vascular complications. Posttransplant antithrombotic therapy seems to be a valuable strategy in pediatric liver transplantation. Identified risk factors for bleeding and thrombotic complications might facilitate a more personalized approach in antithrombotic therapy.

Keywords

antithrombotic therapy - pediatric liver transplantation - bleeding - thrombosis

Supplementary Material

 

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