Liver transplantation: Incidence and management of deep venous thrombosis and pulmonary emboli

Ishitani, M.; Angle, John F.; Bickston, Stephen J.; Caldwell, S.; Isaacs, Ross; Pruett, T.

doi:10.1016/s0041-1345(97)00709-4

Cited by 45 publications

(45 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Intraoperative pulmonary embolism (PE) or intracardiac thrombosis (ICT) have been reported only sporadically in non-oncological patients undergoing other types of major surgery, such as orthopedic and cardiovascular surgery [10][11][12]. Although the estimated incidence of PE or ICT in liver transplant recipients is low (around 1-1.5%) [13,14], these complications are potentially fatal, and therefore of great clinical relevance.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review

Warnaar¹,

Molenaar²,

Colquhoun³

et al. 2008

J Thromb Haemost

122

View full text Add to dashboard Cite

Summary. Background: Pulmonary embolism (PE) and intracardiac thrombosis (ICT) are rare but potentially lethal complications during orthotopic liver transplantation (OLT). Methods: We aimed to review clinical and pathological correlates of PE and ICT in patients undergoing OLT. A systematic review of the literature was conducted using MEDLINE and ISI Web of Science. Results: Seventy-four cases of intraoperative PE and/or ICT were identified; PE alone in 32 patients (43%) and a combination of PE and ICT in 42 patients (57%). Most frequent clinical symptoms included systemic hypotension and concomitant rising pulmonary artery pressure, often leading to complete circulatory collapse. PE and ICT occurred in every stage of the operation and were reported equally in patients with or without the use of venovenous bypass or antifibrinolytics. A large variety of putative risk factors have been suggested in the literature, including the use of pulmonary artery catheters or certain blood products. Nineteen patients underwent urgent thrombectomy or thrombolysis. Overall mortality was 68% (50/74) and 41 patients (82%) died intraoperatively. Conclusion: Mortality was significantly higher in patients with an isolated PE, compared to patients with a combination of PE and ICT (91% and 50%, respectively; P < 0.001). Intraoperative PE and ICT during OLT appear to have multiple etiologies and may occur unexpectedly at any time during the procedure.

show abstract

Section: Introductionmentioning

confidence: 99%

Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review

Warnaar¹,

Molenaar²,

Colquhoun³

et al. 2008

J Thromb Haemost

122

View full text Add to dashboard Cite

show abstract

“…In fact, various articles have demonstrated intraoperative PE [25,26]. In a series of 299 patients who underwent 342 LTs at our center between 1989 and 1995, eleven had documented deep venous thrombosis including three who developed PE [11]. These patients all underwent LT using the older technique of bicaval anastomosis with veno-venous bypass, which may be a risk factor for DVT due to insertion of cannulae into the femoral vein.…”

Section: Discussionmentioning

confidence: 95%

“…Only few studies report on PE after LT; however, it seems that mortality associated with this complication is high. In addition, the increased pressure in the right ventricle and subsequently the vena cava may cause significant hepatic congestion and harm to the freshly implanted graft [11,12]. In the case of PE, sildenafil can acutely lower pulmonary pressure and subsequently improve left ventricular filling, which improves cardiac output and thus may improve arterial perfusion of the liver.…”

Section: Introductionmentioning

confidence: 99%

Use of sildenafil in a liver transplant recipient with acute pulmonary embolism

2010

View full text Add to dashboard Cite

“…Axillobifemoral bypass has been reserved for In addition, we recommended chronic anticoagulation to improve long-term graft patency and venous thromboembolic complications, which occur at higher rates in liver transplant patient. 6,7) Disclosure Statement Naoto Fukunaga and co-workers have no conflict of interest.…”

Section: Discussionmentioning

confidence: 99%

Axillobifemoral Bypass for Aortitis Syndrome in a Living-Donor Liver Transplant Patient

Fukunaga

Uryuhara

Koyama

2016

Annals of Vascular Diseases

View full text Add to dashboard Cite

A 64-year-old female patient with aortitis syndrome presented with progressive intermittent claudication for 6 months. Her medical history was notable for living-donor liver transplantation for primary biliary cirrhosis 4-years prior and chronic immunosuppressive therapy. Evaluation included normal laboratory examination, and contrast-enhanced computed tomography angiography which demonstrated severely calcified descending aorta with high-grade stenosis below the diaphragm. The patient was treated by axillobifemoral bypass using an 8-mm ringed expanded polytetrafluoroethylene graft under general anesthesia. Medical management included decreased preoperative doses of immunosuppressants and predonisolone, which were resumed after the operation, and chronic anticoagulation. There were no postoperative complications. Keywords: axillobifemoral bypass, aortitis syndrome, livingdonor liver transplant Case ReportA 64-year-old female patient presented with intermittent claudication for six months. Intermittent claudication had been worsening gradually. Her medical history was notable for aortitis syndrome, which was successfully treated by chronic predonisolone therapy at 2.5 mg per day. The patients underwent living-donor liver transplantation for primary biliary cirrhosis (PBC) 4 years prior to presentation, which required chronic immunosuppression with Tacrolimus hydrate 2 mg per day and Mycophenolate Mofetil 500 mg per day. The patient was followed closely at by our department of transplantation.Laboratory examinations revealed total bilirubin of 0.5 mg/dL, glutamic oxaloacetic transaminase of 18 IU/L, glutamic pyruvic transaminases of 10 IU/L, alkaline phosphatase of 346 IU/L, cholinesterase of 309 IU/L, creatinine of 1.04 mg/dL, urea of 7.6 mg/dL, HbA1C of 5.9%, white cell count of 6100/L, hemoglobin of 9.7 g/dL, platelet count of 17.1 × 10 4 /L and international ratio of prothrombin time of 1.07.Transthoracic echocardiography revealed normal left ventricular function (69.7%) and no significant valvular diseases. Coronary angiography also revealed intact coronary arteries.Ankle branchial index could not be measured and maximum claudication distance was less than 50 m. A contrastenhanced computed tomography angiography (CTA) was obtained, which showed that severely calcified distal descending aorta (Figs. 1 and 2A) with high-grade stenosis below the diaphragm (Fig. 1A). Celiac trunk was severely stenotic (Fig. 1B) and superior mesenteric artery was occluded. Abdominal aorta was also occluded (Fig. 1C).This patient had a history of laparotomy in living-donor liver transplant and there was heavily calcified descending and abdominal aorta on CTA. Additionally, she required oral chronic immunosuppressants and predonisolone. Based on these concerns, this patient was not considered an ideal candidate for endovascular or open aortic-based reconstruction. Therefore, an extra-anatomic bypass for atypical aortic coarctation was recommended. The doses of immunosuppressants and predonisolone were decreased in anticipation of th...

show abstract

Liver transplantation: Incidence and management of deep venous thrombosis and pulmonary emboli

Cited by 45 publications

References 9 publications

Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review

Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review

Use of sildenafil in a liver transplant recipient with acute pulmonary embolism

Axillobifemoral Bypass for Aortitis Syndrome in a Living-Donor Liver Transplant Patient

Contact Info

Product

Resources

About