The objective of this literature review was to estimate the incidence of thrombosis and thromboembolism associated with the superior cavopulmonary anastomosis (SCPA) procedure and its variants and to examine current thromboprophylaxis regimens utilized. MEDLINE and EMBASE were searched from inception to August 2017 for all prospective and retrospective cohort studies explicitly reporting incidence of thrombosis, thromboembolism, or shunt occlusion in neonates, infants, and children undergoing 1 or more variants of the SCPA procedure. End points included thrombotic events and thromboembolic events (strokes and pulmonary embolisms) as primary outcomes, and overall mortality as a secondary outcome, at the last available follow-up time point. Of 1303 unique references identified, 13 cohort studies were deemed eligible. Reported incidence of thrombosis and thromboembolic events ranged from 0% to 28.0% and from 0% to 12.5%, respectively. Reported incidence of major bleeding events ranged from 0% to 2.9%. Reported overall mortality ranged from 2.5% to 50.5% across studies. Thromboprophylaxis protocols varied across institutions and studies, most commonly involving unfractionated heparin (UFH), warfarin, enoxaparin, acetylsalicylic acid (ASA), or combinations of ASA and warfarin, ASA and low-molecular-weight heparin (LMWH), UFH and LMWH, and UFH and ASA; several studies did not specify a protocol. Due to substantial variability in reported event rates, no clear correlation was identified between prophylaxis protocols and postoperative thrombotic complications. Despite guidance recommending postoperative UFH as standard practice, thromboprophylaxis protocols varied across institutions and studies. More robust trials evaluating different thromboprophylaxis regimens for the management of these patients are warranted.
Although postoperative thromboprophylaxis seems optimal, it remains controversial whether the long-term aspirin use is most effective. Our findings highlight the lack of a gold-standard thromboprophylaxis strategy and emphasize the need for more consistency.
Background: The shortage of donors to meet the demand for transplants is a global problem. Several strategies have been implemented to ameliorate this situation, including the use of "livers that nobody wants" donors. Outcomes should be evaluated. Methods: CRESI-SINTRA and retrospective data base were used to analyze transplant activity in Argentina and in the Hospital El Cruce (HEC), respectively during 2013e2016. 2 pre-specified groups: 1. patients receiving an organ beyond percentile 75 (p75) of the median of the rejected offers before graft acceptance. 2. rest of receptors. Percentages and median (with interquartile range/IQR), chi2 and Wilconxon Rank Sum test, Kaplan-Meier/log rank sum test were used. A p < 0.05 was considered statistically significative. Results: 1325 liver transplants were performed nationally, 5 (IQR 3-11) as median of rejected offers before graft acceptance. 153 were performed in HEC, and its median was 7 (IQR 3-18), 55/36% of those grafts beyond p75; none used for acute liver failure. Comparing 1 vs 2 (55 vs 72), there were no differences in age, primary nonfunction, early extubation, dialysis, ICU and total length stay, graft and patient survival. Receptor's MELD was the only difference (24 IQR 22-25 vs 28 IQR 25-33 p < 0.05). Conclusion: One third of the population of our center received "livers that nobody wants" (grafts previously rejected 12 times), with similar results. Future research should determine the causes of such rejections.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.