Poster 29. Risk Factors for Thrombosis and Bleeding in Pediatric Liver Transplantation in an Era of Routine Postoperative Antithrombotic Therapy

Thursday 14 march 2019

13:09 - 13:12h

Categories: Klinisch, Postersessie

Parallel session: Postersessies 6 - Clinical

M.J.M. Werner1, R.H.J. de Kleine1, M.T. de Boer1, V.E. de Meijer1, R. Scheenstra2, H.J. Verkade3, F.A.J.A. Bodewes3, S.T.H. Bontemps4, K.M.E.M. Reyntjens5, R. Dikkers6, T. Lisman7, R.J. Porte1

1Dept. of Hepatobiliary Surgery and Liver Transplantation, 2Dept. of Pediatric Gastroenterology and Hepatology,  3Dept. of Pediatric Gastroenterology and Hepatology, 4Dept. of Pediatric Intensive Care,5Dept. of Anesthesiology,6Dept. of Pediatric Radiology,7Dept. of Surgery, Section Surgical Research Laboratory, University Medical Center Groningen, Groningen,  The Netherlands.

Background: Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) are serious causes of morbidity and mortality after pediatric liver transplantation. In order to reduce the number of thrombotic complications, routine antithrombotic therapy, consisting of 1 week heparin followed by 3 months acetylsalicylic acid, was implemented in our pediatric liver transplant program in 2003. The aim of this study is to evaluate the incidence of bleeding and thrombotic complications since the implementation of routine antithrombotic therapy and to identify risk factors for these complications.

Methods: A retrospective cohort study including all 200 pediatric primary liver transplantations performed between 2003-2016. Uni- and multivariate logistic regression analysis, the Kaplan-Meier method and Cox regression analysis were used to evaluate recipient outcome.

Results: Fifty-six (28%) full size and 144 (72%) partial grafts from 161 (80%) deceased and 39 (20%) living donors were transplanted. HAT occurred in 15 (7.5%), PVT in 4 (2.0%) and venous outflow thrombosis in 2 (1.0%) recipients. Intra-operative vascular interventions (OR 14.4 (3.7-55.7)), recipient age (OR 0.81 (0.69-0.95)) and donor age (OR 0.96 (0.93-0.99)) were associated with post-transplant thrombosis. Clinically relevant bleeding occurred in 37%. Risk factors for post-transplant bleeding were high recipient age (OR 1.08 (1.02-1.15)), high Child-Pugh scores (OR 1.14 (1.02-1.28)) and intra-operative blood loss (OR 1.003 (1.001-1.006)). Both post-transplant thrombotic (HR 3.4 (1.4-8.5);P=0.009) and bleeding complications (HR 2.5 (1.2-5.2); P=0.015) increased mortality.

Conclusions: In 200 consecutive pediatric liver transplant recipients receiving routine post-operative antithrombotic therapy we report low incidences of post-transplant vascular complications. Post-transplant routine antithrombotic therapy seems to be valuable for pediatric liver transplant care. The identified risk factors for bleeding and thrombotic complications may facilitate a more personalized approach to antithrombotic therapy.