Low-dose Heparin Therapy During Living Donor Right Hepatectomy Is Associated With Few Side Effects and Does Not Increase Vascular Thrombosis in Liver Transplantation

Yoo, Tae; Kim, S.H.; Kim, Y.-K.; Cho, S.Y.; Park, S.-J.

doi:10.1016/j.transproceed.2012.02.043

Cited by 11 publications

(22 citation statements)

References 3 publications

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“…3,22 In addition, recent studies have suggested that systemic heparinization may increase the risk of intraoperative and early postoperative bleeding. 4,5,8 In fact, several transplant centers have found that abandoning the use of systemic heparin during LDN reduced donor complication rates (including hemorrhage) without impairing graft function. 5,6,8,9,23 Also, protamine sulfate, used to reverse the anticoagulative effects of heparin, may adversely affect living donors.…”

Section: Discussionmentioning

confidence: 99%

“…Although several studies have indicated that the routine use of heparin is not necessary during LDN, no consensus has yet emerged, and no guidelines on optimal heparin dosages are available. [3][4][5]9,23 Furthermore, it remains unclear whether systemic heparin affects donor complication rates or the rate of graft vascular thrombosis in LDLT. 4 Yoo et al 4 suggested that the administration of lowdose heparin (25 IU/kg) before graft procurement reduced bleeding complications without worsening graft vascular thrombosis in comparison with the conventional dose (50 IU/kg).…”

Section: Discussionmentioning

confidence: 99%

“…3 Systemic heparinization during living donor hepatectomy (LDH) has been performed routinely at most transplant centers because the procedure may prevent graft vascular thrombosis during the warm ischemia period, which could, in turn, impair graft function or even cause graft loss. 3,4 However, the use of heparin increases the risks of intra-and postoperative bleeding in living donors, and the use of protamine sulfate to reverse the anticoagulant effects of heparin is associated with severe complications, including anaphylactic reactions and pulmonary hypertension. [4][5][6] No guidelines on the use of systemic heparinization or the optimal dosage given during LDH are available.…”

mentioning

confidence: 99%

“…3,4 However, the use of heparin increases the risks of intra-and postoperative bleeding in living donors, and the use of protamine sulfate to reverse the anticoagulant effects of heparin is associated with severe complications, including anaphylactic reactions and pulmonary hypertension. [4][5][6] No guidelines on the use of systemic heparinization or the optimal dosage given during LDH are available. 3,4 Indeed, trials that deliberately omitted systemic heparin reported lower donor complication rates and no evidence of impaired graft function in living donor nephrectomy (LDN) patients.…”

mentioning

confidence: 99%

“…[4][5][6] No guidelines on the use of systemic heparinization or the optimal dosage given during LDH are available. 3,4 Indeed, trials that deliberately omitted systemic heparin reported lower donor complication rates and no evidence of impaired graft function in living donor nephrectomy (LDN) patients. [5][6][7][8][9] Few reports have verified the effects of systemic heparinization on donor complications or graft vascular thrombosis after LDLT.…”

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confidence: 99%

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Is Systemic Heparinization Necessary during Living Donor Hepatectomy?

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Is Systemic Heparinization Necessary during Living Donor Hepatectomy?

et al. 2018

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Is Systemic heparinization necessary during living donor hepatectomy?

2015

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Systemic heparinization has traditionally been performed during living donor hepatectomy (LDH) at most transplant centers because of the possibility of graft vascular thrombosis. However, no consensus on the use of systemic heparinization during LDH has yet emerged. The aims of the present study were to compare donor and recipient outcomes with reference to systemic heparinization and to determine whether or not systemic heparin needs to be administered to living donors. Via a retrospective review, we analyzed the outcomes of 137 LDHs performed at our institution from January 2011 to October 2013; 79 donors received systemic heparinization (group I), whereas 58 did not, but the liver graft was flushed with a heparinized perfusate (group II). Patient demographics, intraoperative parameters, laboratory data, postoperative complications, and survival rates were compared between the 2 groups. The overall complication rates did not differ significantly between the 2 groups, but postoperative bleeding requiring red blood cell transfusions occurred more frequently in group I versus group II (7.6% versus 0.0%, P = 0.03). The incidences of graft vascular thrombosis were similar in the 2 groups, and no graft loss caused by vascular thrombosis was evident during the early postoperative period. Moreover, no difference in either posttransplant graft function or survival was apparent between the 2 groups. The rates of decreases in donor hemoglobin, hematocrit, and platelet count levels during the early postoperative period were significantly higher in group I versus group II. In conclusion, the omission of systemic heparinization during LDH is both feasible and safe, with no adverse effects on donor or recipient outcomes. Liver Transpl 21:239‐247, 2015. © 2014 AASLD.

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Fibrinolysis after reperfusion of liver graft

Poon

Chen

Thorat

et al. 2015

Acta Anaesthesiologica Taiwanica

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From September 2012 to March 2013, a total of 63 adult-to-adult living donor liver transplantations were performed at our institution. All the patients were monitored for their coagulation functions using rotation thromboelastometry (ROTEM, Tem Innovations GmbH) during the procedure at the following points: preoperative baseline, 5 minutes, 30 minutes, and 120 minutes, respectively, after reperfusion of the liver graft. A total of 84.13% of cases (n = 53) revealed fibrinolysis after reperfusion of the graft and the condition was reversed after 30 minutes without any need for additional treatment. No significant coagulopathy was observed during this period in all of the cases. The result of the ROTEM finding must correlate with the clinical situation before instituting any management to avoid the risk of thrombosis of the hepatic artery.

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Low-dose Heparin Therapy During Living Donor Right Hepatectomy Is Associated With Few Side Effects and Does Not Increase Vascular Thrombosis in Liver Transplantation

Cited by 11 publications

References 3 publications

Is Systemic Heparinization Necessary during Living Donor Hepatectomy?

Is Systemic Heparinization Necessary during Living Donor Hepatectomy?

Is Systemic heparinization necessary during living donor hepatectomy?

Fibrinolysis after reperfusion of liver graft

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