Deep Vein Thrombosis and Pulmonary Embolism in Liver Transplant Patients

Abstract

IntroductionDeep vein thrombosis (DVT) and pulmonary embolism (PE) are surgical complications estimated to occur in 5% to 10% of patients. There are limited data regarding DVT/PE in the early postoperative period in liver transplant patients. The aim of this study is to determine risk factors that influence the incidence of DVT/PE and the effectiveness of prophylaxis.MethodsWe reviewed the records of 999 patients who underwent initial liver transplant between January 2000 and June 2012 at Henry Ford Hospital. In 2011, a standardized prophylactic regimen using subcutaneous (SQ) heparin was initiated. All patients that developed either upper/lower extremity DVT or PE within the first 30 days of transplant formed the cohort of this study.ResultsOn multivariate analysis, only peripherally inserted central catheter (PICC) placement and SQ heparin were associated with DVT/PE. In patients receiving heparin, 3 (1.0%) had DVT/PE versus 25 (3.5%) who did not receive heparin (P = 0.03). Sixteen (6.9%) patients that had a PICC developed DVT/PE compared with 12 (1.6%) patients without a PICC (P < 0.001). In the heparin group, DVT/PE with PICC was reduced to 3 (3.0%) versus 13 (9.9%) in those with a PICC and did not receive heparin (P = 0.03). Mean time from transplant to DVT/PE diagnosis was 12.3 days. Length of hospitalization was significantly longer in patients who developed DVT/PE (18.5 vs 10.0 days, P < 0.001).ConclusionsIn this study, we demonstrated that PICC placement significantly increases the likelihood of DVT/PE in liver transplant recipients. Prophylactic SQ heparin effectively reduced DVT/PE events in this patient population.

Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

“…Liver transplantation (LT) is the only longterm therapy for patients with cirrhosis. This complex procedure is still fraught with hemorrhage and thrombosis . In this retrospective study, we report the association of abnormal fibrinolysis phenotypes with poorer outcomes during and after LT.…”

Cardiovascular disease risk in patients receiving organ transplantation: a national cohort study

“…However, a growing body of evidence has established that patients with cirrhosis and those after liver transplantation may actually demonstrate a hypercoagulative state during and after the transplant procedure [28]. As complex and unpredictable in onset and severity, a few risk factors for venous thromboembolism after liver transplantation were identified, for example, prolonged immobilization, administration of excessive procoagulant factors, and peripherally inserted central catheter lines [14,15]. Other factors involved defects in the proteins that normally regulated anticoagulation, such as protein C, protein S, and antithrombin deficiency, transmitted from donors to recipients [29][30][31][32], and this can be missed Similarly, kidney and heart transplant recipients have been reported to be at risk of venous thromboembolism as mentioned previously [16,18,[33][34][35].…”

Hemostatic Complications in Hepatobiliary Surgery

“…These reports showed incidences varying between 4.5 and 8.6%. [80][81][82][83][84] Notably, the study that reported an incidence of 8.6% only considered the number of deep vein thrombosis, 82 an even higher incidence would likely have been found if pulmonary embolisms had been taken into account. Importantly, none of the patients in this study received pharmacological thromboprophylaxis.…”