Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

Abstract

BackgroundVascular complications, such as HAT, are an important cause of graft loss and recipient mortality. We aimed to characterize post-transplant thrombotic events in a cohort of liver transplant recipients, and identify independent risk factors for these complications.MethodsWe conducted a thrombophilic study of 293 orthotopic liver transplants performed in the Digestive Surgery Department of the 12 de Octubre Hospital (Madrid, Spain) between January 2001 and December 2006.ResultsThe most frequent post-transplant thrombotic events were HAT (9%) and PVT (1.7%). The one variable associated with post-transplant thrombotic event was a high fibrinogen level in the global cohort of liver transplantation. But toxicity as event post-OLT has been associated with post-transplant thrombotic event in the retrospective group and high fibrinogen level and low protein C levels were associated post-transplant thrombotic event in the prospective group. Liver disease relapse (HR 6.609, p < 0.001), high levels of FVIII (HR 1.008, p = 0.019)) and low levels of antithrombin (HR 0.946, p < 0.001) were associated with poor overall survival (OS).In conclusion, high fibrinogen and decreased protein C levels were associated with allograft thrombosis. Further studies are required in order to assess the clinical relevance of these parameters in prospective studies and to study the effect of anticoagulation prophylaxis in this group of risk.

Bleeding and thrombotic complications of pediatric liver transplant

“…1–9 Hepatic artery and portal vein thrombosis are reported at rates of 5–15% in pediatric cohorts, which is 3–4 times the incidence in adults. 2,5–11 Bleeding estimates are harder to quantify given variability in the definition of major bleeding, but range from approximately 5–9%. 12–14 The contribution of bleeding to morbidity is difficult to quantify, but thrombotic complications are known to reduce graft survival and contribute significantly to adverse outcomes, with mortality rates approaching 50% in those with hepatic artery thrombosis.…”

Antiphospholipid syndrome, antiphospholipid antibodies and solid organ transplantation

“…7 Fifty-eight (12.8%) patients developed a post-transplant thrombotic event, but no relationship with the presence of aCL antibodies was found. In this study LA and aB2GPI antibodies were not determined.…”

“…None of 12 patients with positive aPL antibodies presented complications. Ayala 7 Retrospective and prospective analysis.…”

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“…Another important risk factor is acute rejection episodes, which increase the capillary bed resistance and impede arterial flow. 5,[8][9][10] We encountered 1 patient who developed HAT because of acute rejection on postoperative day 14, for which retransplant was done because of graft failure, but HAT recurred because of recurrence of acute rejection after retransplant. Interrupted sutures are associated with fewer hepatic arterial complications.…”