Feasibility and Effectiveness of a New Algorithm in Preventing Hepatic Artery Thrombosis after Liver Transplantation

Müller, Sascha; Schmied, Bruno M.; Mehrabi, Arianeb; Welsch, Thilo; Schemmer, Peter; Hinz, Ulf; Weitz, Jürgen; Werner, Jens; Büchler, Markus W.; Schmidt, Jan

doi:10.1007/s11605-008-0753-y

Cited by 8 publications

(7 citation statements)

References 45 publications

(49 reference statements)

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“… 8 , 9 Previous history of HAT, low donor body weight, and complex arterial reconstruction have been described as risk factors for the development of HAT. 4 , 10 - 12 In an attempt to prevent HAT, all current adult LT recipients are placed on long-term antiplatelet therapy with low-dose aspirin which may have contributed to lower the incidence of HAT from 7.6% to 6.5% at our institution. 4 …”

Section: Discussionmentioning

confidence: 99%

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Retransplantation in Late Hepatic Artery Thrombosis: Graft Access and Transplant Outcome

Buchholz

Khan

David

et al. 2017

Transplantation Direct

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BackgroundDefinitive treatment for late hepatic artery thrombosis (L-HAT) is retransplantation (re-LT); however, the L-HAT–associated disease burden is poorly represented in allocation models.MethodsGraft access and transplant outcome of the re-LT experience between 2005 and 2016 was reviewed with specific focus on the L-HAT cohort in this single-center retrospective study.ResultsNinety-nine (5.7%) of 1725 liver transplantations were re-LT with HAT as the main indication (n = 43; 43%) distributed into early (n = 25) and late (n = 18) episodes. Model for end-stage liver disease as well as United Kingdom model for end-stage liver disease did not accurately reflect high disease burden of graft failure associated infections such as hepatic abscesses and biliary sepsis in L-HAT. Hence, re-LT candidates with L-HAT received low prioritization and waited longest until the allocation of an acceptable graft (median, 103 days; interquartile range, 28-291 days), allowing for progression of biliary sepsis. Balance of risk score and 3-month mortality score prognosticated good transplant outcome in L-HAT but, contrary to the prediction, the factual 1-year patient survival after re-LT was significantly inferior in L-HAT compared to early HAT, early non-HAT and late non-HAT (65% vs 82%, 92% and 95%) which was mainly caused by sepsis and multiorgan failure driving 3-month mortality (28% vs 11%, 16% and 0%). Access to a second graft after a median waitlist time of 6 weeks achieved the best short- and long-term outcome in re-LT for L-HAT (3-month mortality, 13%; 1-year survival, 77%).ConclusionsInequity in graft access and peritransplant sepsis are fundamental obstacles for successful re-LT in L-HAT. Offering a graft for those in need at the best window of opportunity could facilitate earlier engrafting with improved outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Conservative management of L-HAT is only successful in a minority, and many L-HAT patients are either too sick to be relisted or die on the waiting list. 12 , 18 In fact, although it is reported that the incidence of L-HAT exceeds the occurrence of early HAT, re-LT for L-HAT is less common. 4 …”

Section: Discussionmentioning

confidence: 99%

Retransplantation in Late Hepatic Artery Thrombosis: Graft Access and Transplant Outcome

Buchholz

Khan

David

et al. 2017

Transplantation Direct

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“…We performed a post hoc analysis of a prospectively conducted registry database study ( 4 ) on adult patients who underwent orthotopic liver transplantation at our center between January 1st, 2004 and December 31st, 2017, to assess whether perioperative PCC or fibrinogen administration is associated with thrombotic complications. Patients were included if enrolled in the surgical database and anesthesia and intensive care unit (ICU) records were available.…”

Section: Methodsmentioning

confidence: 99%

“…Thrombotic events after liver transplantation are serious complications associated with an adverse outcome. Hepatic artery thrombosis (HAT), portal vein thrombosis (PVT), and thrombosis of the inferior vena cava occur at frequencies of up to 9, 2, and 2%, respectively (1)(2)(3)(4). HAT can further be divided into early (occurring within 1 month after liver transplantation) or late HAT events (5).…”

Section: Introductionmentioning

confidence: 99%

“…The underlying mechanisms are multifactorial and remain partly unclear ( 9 ). The risk factors for early HAT are the most commonly described and include intraoperative reconstruction of arteries ( 4 , 10 ), pre-existing HAT, previous abdominal surgeries, duration of surgery, cold ischemia time, and female sex as well as the age of both the recipient and the donor, split liver transplantation, higher recipient/donor weight ratio, recipient/donor cytomegalovirus (CMV) mismatch, retransplantation or increased red blood cells (≥6 units), and the need for fresh frozen plasma (≥10 units) transfusion ( 5 – 7 , 9 , 11 – 13 ). In the past two decades, the use of recombinant coagulation factors—in particular fibrinogen and prothrombin complex concentrates (PCC)—during liver transplantation has increased.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative prothrombin complex concentrate and fibrinogen administration are associated with thrombotic complications after liver transplant

et al. 2022

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BackgroundUse of intraoperative prothrombin complex concentrates (PCC) and fibrinogen concentrate administration has been linked to thrombotic events. However, it is unknown if its use is associated with thrombotic events after liver transplant.Methods and analysisWe conducted a post hoc analysis of a prospectively conducted registry database study on patients who underwent liver transplant between 2004 and 2017 at Heidelberg University Hospital, Heidelberg, Germany. Univariate and multivariate analyses were used to determine the association between PCC and fibrinogen concentrate administration and thrombotic complications.ResultsData from 939 transplantations were included in the analysis. Perioperative PCC or fibrinogen administration was independently associated with the primary composite endpoint Hepatic artery thrombosis (HAT), Portal vein thrombosis (PVT), and inferior vena cava thrombosis [adjusted HR: 2.018 (1.174; 3.468), p = 0.011]. PCC or fibrinogen administration was associated with the secondary endpoints 30-day mortality (OR 4.225, p < 0.001), graft failure (OR 3.093, p < 0.001), intraoperative blood loss, red blood cell concentrate, fresh frozen plasma and platelet transfusion, longer hospitalization, and longer length of stay in intensive care units (ICUs) (all p < 0.001). PCC or fibrinogen administration were not associated with pulmonary embolism, myocardial infarction, stroke, or deep vein thrombosis within 30 days after surgery.ConclusionA critical review of established strategies in coagulation management during liver transplantation is warranted. Perioperative caregivers should exercise caution when administering coagulation factor concentrate during liver transplant surgery. Prospective randomized controlled trials are needed to establish causality for the relationship between coagulation factors and thrombotic events in liver transplantation. Further studies should be tailored to identify patient subgroups that will likely benefit from PCC or fibrinogen administration.

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The Transplant Operation

McCormack¹,

Selzner²,

Clavien³

2006

Medical Care of the Liver Transplant Patient

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Feasibility and Effectiveness of a New Algorithm in Preventing Hepatic Artery Thrombosis after Liver Transplantation

Abstract: Therefore, we have implemented the presented algorithm, which showed an acceptable HAT rate.

Cited by 8 publications

References 45 publications

Retransplantation in Late Hepatic Artery Thrombosis: Graft Access and Transplant Outcome

Retransplantation in Late Hepatic Artery Thrombosis: Graft Access and Transplant Outcome

Perioperative prothrombin complex concentrate and fibrinogen administration are associated with thrombotic complications after liver transplant

The Transplant Operation

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