Hemostatic status in liver transplantation: Association between preoperative procoagulants/anticoagulants and postoperative hemorrhaging/thrombosis

Abstract

The delicate rebalanced hemostatic status of liver transplant recipients may lead to both hemorrhagic and thrombotic tendencies in this population. The aim of this study was to investigate the association between pretransplant procoagulants/ anticoagulants and posttransplant bleeding and thrombosis among living donor liver transplant recipients. The study subjects were 403 consecutive recipients with chronic liver disease. Perioperative variables, including preoperative values for procoagulants and anticoagulants, were assessed to determine their association with posttransplant hemorrhaging and thrombosis. There were 35 hemorrhagic complications (9%) and 21 thrombotic complications (5%). In logistic regression analyses, a higher Model for End-Stage Liver Disease score (P 5 0.01) and a lower fibrinogen value (P < 0.001) were independently associated with hemorrhaging, whereas only a lower protein C value (P < 0.001) was independently associated with thrombosis. In a receiver operating characteristic analysis, a low preoperative protein C value (with the most accurate cutoff value being 25%) was a reliable predictor of thrombotic complications after liver transplantation (area under the curve 5 0.921, P < 0.001, sensitivity 5 0.9, specificity 5 0.8). In conclusion, the decreases in both procoagulants and anticoagulants in liver transplant recipients may additively result in a delicate hemostatic balance and predispose patients to both hemorrhagic and thrombotic complications. A lower preoperative protein C value (<25%) was demonstrated to be a significant and reliable predictor of postoperative thrombotic complications in liver transplant recipients. Liver Transpl 21:258-265, 2015. V C 2014 AASLD.

Clinical Significance of Spontaneous Portosystemic Shunts in Living Donor Liver Transplantation

“…(18) Our posttransplant anticoagulation regimen was also described previously. (19) sHUnt evalUatiOn A shunt was defined as a natural venous communication between portal and caval systems in the presence of liver cirrhosis. A pre-LDLT 3-dimensional, enhanced computed tomography scan at the venous phase (within 1 month prior to LT) was reviewed by an author (M.A.A.)…”

Simultaneous ABO-incompatible living-donor liver transplantation and splenectomy without plasma exchange in China: Two case reports

“…The plasma concentration of coagulant and anticoagulant proteins is disturbed after liver transplantation, leading to a hypercoagulable condition that contributes to vascular thrombosis with an incidence rate of 5%. 19 In our cases, however, the anticoagulation protocol involving xueshuantong injection, aspirin, and Gingko leaves extract was effective to prevent formation of thrombosis in the hepatic portal system and splenic vein.…”

Application of Various Surgical Techniques in Orthotopic Liver Transplantation: a 10-year Experience at a Single Center

“…Abdominal bleeding is related to the preoperative patients' condition, operation techniques and postoperative anticoagulation 34,35 . Nobuhisa et al 36 reported that a higher MELD score, intraoperative blood loss and low brinogen value increase the incidence of postoperative abdominal bleeding. Our result revealed that it was not signi cantly different among the different techniques.…”