Frequency of and factors associated with vascular complications after pediatric liver transplantation

Orlandini, Mariana Seidl Gomes; Feier, Flávia Heinz; Jaeger, Brunna De Bem; Kieling, Carlos Oscar; Vieira, S; Zanotelli, Maria Lúcia

doi:10.1016/j.jped.2013.08.010

Cited by 47 publications

(56 citation statements)

References 28 publications

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“…They also found those patients who developed vascular complications had younger donors than those who did not, though the difference was not statistically significant (median age 5 vs 12, P = .084). Because of these findings, they suggest that WL grafts from small young donors may have an innate predisposition to developing post‐operative HAT, even when carefully size matched to recipient weight . In our study, we found that patients who developed HAT following WL had significantly younger donors (Table ).…”

Section: Discussionsupporting

confidence: 91%

Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg

Kim

Ramos‐Gonzalez

Staffa

et al. 2019

Pediatric Transplantation

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Hepatic artery thrombosis (HAT) following pediatric liver transplantation increases morbidity and risk of graft failure. We performed a retrospective chart review of all patients who underwent deceased‐donor liver transplantation from August 2002 to July 2016. Multi‐organ transplant recipients were excluded. We examined the incidence of HAT at our institution and sought to identify associated donor or recipient risk factors. A total of 127 deceased‐donor liver transplant patients with a median age of 1.7 years (IQR 0.67‐6.7) were identified. Of those, 14 developed HAT, all weighing under 25 kg. Among 100 patients under 25 kg, whole‐liver graft recipients had an odds ratio of 3.98 (95% confidence interval [CI]: 1.03, 15.34; P = .045) for developing HAT compared with split‐liver graft recipients. Within the whole‐liver recipient group under 25 kg, 11 patients developed HAT with a median donor‐to‐recipient ratio (DRWR) of 0.9 (IQR: 0.7‐1.2) compared with a median DRWR of 1.4 (IQR: 1.1‐1.9) for those who did not develop HAT. Multivariate analysis showed DRWR to be an independent risk factor for HAT in patients weighing under 25 kg who received whole organ grafts, with an odds ratio of 3.89 (95% CI: 1.43, 10.54; P = .008) for each 0.5 unit decrease in DRWR. Our results suggest that in recipients under 25 kg 1) split‐liver grafts may have a lower rate of HAT and 2) selecting whole organ donors with a higher DRWR may decrease the incidence of HAT.

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Section: Discussionsupporting

confidence: 91%

Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg

Kim

Ramos‐Gonzalez

Staffa

et al. 2019

Pediatric Transplantation

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“…Portal vein hypoplasia is also one of the main risk factors for vascular complications following pediatric liver transplantation, especially in children with biliary atresia . An intraoperative finding of portal diameter ≤3 mm was a statistically significant predictor of vascular complications in the post‐operative period . Previous studies have reported that a hypercoagulable state following pediatric LRDLT is another important risk factor for vascular thrombosis.…”

Section: Discussionmentioning

confidence: 94%

Clinical study of argatroban for preventing vascular thrombosis in the early period after pediatric living‐related donor liver transplantation

2020

Pediatric Transplantation

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Objective To evaluate the effect of heparin and argatroban on coagulation function and vascular thrombosis in the early period after pediatric LRDLT. Method Eighty‐four congenital biliary atresia pediatric patients who had undergone LRDLT were studied. Patients were divided into two groups according to the method of anticoagulation (heparin or argatroban). AT‐Ⅲ activity, APTT, and INR of the two groups were measured in the first 5 days after LRDLT. Vascular thrombosis was investigated by Doppler ultrasound daily. Results There were no significant differences in gender, age, weight, graft‐recipient weight ratio, and Kasai procedure between the two groups. The AT‐Ⅲ activity of the two groups was low and increased gradually after surgery, with no significant difference between the two groups. There was no significant difference of APTT between the two groups immediately after and in the first day after surgery. After anticoagulation treatment, a significant difference in APTT between the two groups was observed. The incidences of vascular thrombosis were 4.76% (3/63) and 0% (0/21) in the heparin and argatroban groups, respectively, with no significant difference between the two groups. During the treatment, no serious complications such as active hemorrhage or drug allergy were observed in the two groups. Conclusion Argatroban is a direct anticoagulant, which is independent of AT‐Ⅲ activity. Argatroban might be an alternative to heparin in uncomplicated LRDLT with recovered hepatic and coagulation function.

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“…[8] In LT recipients, it has been reported that the occurrence rate of PVT was more in patients with HCC, autoimmune chronic active hepatitis, cryptogenic cirrhosis, alcoholic liver disease, or patients with previous treatment of portal hypertension-related bleeding. [8] Orlandini et al [9] found that the following factors, including portal vein diameter ≤3 mm, donor-to-recipient body weight ratio, prolonged ischemic time, and use of arterial grafts, associated with vascular complications in patients undergoing orthotopic liver transplantation. The incidence of vascular complications in patients with portal vein (PV) diameter >3 mm or ≤3 mm are about 20% or 50%, respectively, after 10 years of orthotopic liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of vascular complications in patients with portal vein (PV) diameter >3 mm or ≤3 mm are about 20% or 50%, respectively, after 10 years of orthotopic liver transplantation. [9] Although the survival rates between patients with PVT and patients without PVT had no difference, Neto et al [3] proved that the use of vascular grafts in living donor liver transplantation was an independent risk factor for the occurrence of PVT. The other common factors include excessive length of portal vein, hypercoagulability, thrombus history, portal manipulation, and caliber discrepancies between the donor and recipient veins.…”

Section: Discussionmentioning

confidence: 99%

Left branch of portal vein thrombosis in a liver transplant recipient with donation after cardiac death donor

Chen¹,

Wang²,

Lin

et al. 2016

Medicine

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Introduction:Portal vein thrombosis (PVT) is one of the most severe complications after liver transplantation, which usually causes graft loss and recipient mortality. The founding of the embolic branch of portal system and its result are not well described in the literature.Clinical findings and diagnoses:We report here an unusual case of complete right branch thrombosis of portal vein after orthotopic liver transplantation from a donation after cardiac death donor, without obvious malaise.The interventions and outcomes:The branch thrombosis of portal vein was detected by Doppler ultrasound 11 days after transplantation, followed by angiography for further verification. After treatment with urgent indwelling catheter thrombolysis with urokinase, results improved and the patient showed stable liver function. The patient has been in remission for 22 months with normal graft function.Conclusion:In this case report, we show that frequent ultrasound inspection should be adopted to detect the unobstructed vessel in the early stage of liver transplantation, and local thrombolytic therapy can be used to prevent liver injury and keep the vessel open.

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Frequency of and factors associated with vascular complications after pediatric liver transplantation

Cited by 47 publications

References 28 publications

Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg

Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg

Clinical study of argatroban for preventing vascular thrombosis in the early period after pediatric living‐related donor liver transplantation

Left branch of portal vein thrombosis in a liver transplant recipient with donation after cardiac death donor

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