Effect of Perioperative Coagulation Monitoring by Sonoclot on Short-Term Thrombosis in Pediatric Liver Transplantation

Abstract

Background Sonoclot devices are used to monitor coagulation function in transplant patients. However, the appropriate value of Sonoclot parameters for reducing postoperative thrombosis in pediatric liver transplantation is not clear. Therefore, the aim of the study was to investigate the effect of coagulation monitoring by Sonoclot devices on early postoperative thrombosis after liver transplantation in children. Method The clinical data of 200 children with elective liver transplantation were collected. The effects of coagulation function monitoring by Sonoclot devices 1 h after ischemia-reperfusion on early thrombosis were analyzed. Receiver operating characteristic (ROC) analysis was used to obtain the sensitivity and cutoff value of Sonoclot parameters for the diagnosis of thrombosis. Results A total of 38 (19%) patients had thrombosis complications. 23 cases (11.5%) had postoperative hepatic artery thrombosis and 15 cases (7.5%) had portal vein and hepatic vein thrombosis. Sonoclot coagulation parameters included the following: for the thrombosis group & non-thrombosis group, whole blood activated clotting time (ACT): 178.5 ± 33.2 & 280.4 ± 58.6 (p < 0.05), clotting rate (CR): 12.4 ± 5.4 & 11.5 ± 5.7 (p > 0.05), and platelet function (PF): 3.0±1.4 & 2.6±1.1 (p>0.05). Univariate and multivariate analyses showed that ACT was an independent risk factor for postoperative thrombosis. ROC analysis found that the sensitivity of ACT for the diagnosis of postoperative thrombosis was 94.7%, and the ACT cutoff value to predict early postoperative thrombosis was 228.5 s. Conclusion ACT after ischemia-reperfusion was a risk factor for early postoperative thrombosis. It is recommended that ACT be maintained above 228.5 s to reduce postoperative thrombosis.Trial registrationApproval was obtained from the Ethics Committee of Tianjin First Center Hospital in China (Approval Number: 2016N0039KY), and written informed consent was obtained from eligible guardians. This study has been registered in clinical trial (ClinicalTrials.gov ID: ChiCTR1900026125). All processes were ethical.