Living Donor Liver Transplantation: Usefulness of Hemostatic and Prothrombotic Screening in Potential Donors

BackgroundVascular complications, such as HAT, are an important cause of graft loss and recipient mortality. We aimed to characterize post-transplant thrombotic events in a cohort of liver transplant recipients, and identify independent risk factors for these complications.MethodsWe conducted a thrombophilic study of 293 orthotopic liver transplants performed in the Digestive Surgery Department of the 12 de Octubre Hospital (Madrid, Spain) between January 2001 and December 2006.ResultsThe most frequent post-transplant thrombotic events were HAT (9%) and PVT (1.7%). The one variable associated with post-transplant thrombotic event was a high fibrinogen level in the global cohort of liver transplantation. But toxicity as event post-OLT has been associated with post-transplant thrombotic event in the retrospective group and high fibrinogen level and low protein C levels were associated post-transplant thrombotic event in the prospective group. Liver disease relapse (HR 6.609, p < 0.001), high levels of FVIII (HR 1.008, p = 0.019)) and low levels of antithrombin (HR 0.946, p < 0.001) were associated with poor overall survival (OS).In conclusion, high fibrinogen and decreased protein C levels were associated with allograft thrombosis. Further studies are required in order to assess the clinical relevance of these parameters in prospective studies and to study the effect of anticoagulation prophylaxis in this group of risk.

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“…Donors did not experience thrombotic events, neither during the immediate post-transplant nor during the follow-up periods [13]. …”

Section: Resultsmentioning

confidence: 99%

“…Live donor candidates were excluded from donation if they presented any abnormalities in the hemostatic study, due to genetic mutations, anticoagulant protein deficiencies, factor VIII deficiency or high levels of anticardiolipin antibodies [13]. …”

Section: Resultsmentioning

confidence: 99%

Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

et al. 2011

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“…A consensus should be sought before discussion of risks with the patient. Ghobrial et al Chhibber et al Gruttadauria et al Chan et al Some centers advocate extensive blood test and investigations to rule out malignancies, abnormalities of coagulation [19,20] and lipid disorders [21]. Certainly, close relatives of recipients with inherited hepatic disorders should be carefully scrutinized.…”

Section: Anesthesia Assessmentmentioning

confidence: 99%

Anesthesia and outcome after partial hepatectomy for adult-to-adult donor transplantation

Hwang

McCluskey

2010

Current Opinion in Organ Transplantation

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“…Hypercoagulability risk and metabolic disease are the 2 most common medical reasons for donor exclusion. Hemostasis and thrombosis defect are known to increase the risk of intraoperative and postoperative complications, together with the possible transfer of this defect from graft to recipient . Coagulation screening including platelet count, prothrombin time/activated partial thromboplastin time, fibrinogen, and D‐dimer are already included in the standard laboratory screening for potential donors.…”

Section: Discussionmentioning

confidence: 99%

“…Hemostasis and thrombosis defect are known to increase the risk of intraoperative and postoperative complications, together with the possible transfer of this defect from graft to recipient. (10,25,26) Coagulation screening including platelet count, prothrombin time/ activated partial thromboplastin time, fibrinogen, and D-dimer are already included in the standard laboratory screening for potential donors. However, performing these studies is not sufficient to evaluate the risk of a hypercoagulability state.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

et al. 2017

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The process of evaluating potential donors in liver transplantation is important to ensure donor safety and provide optimal recipient outcomes. However, there has been no report about donor exclusion rates and reasons for such exclusion in Korea. In this study, we aimed to elucidate the outcomes of potential living liver donor evaluation in a major living donor liver transplantation center. From July 2011 to June 2015, prospectively collected data of 726 potential donors for 588 matched recipients were subsequently evaluated. Among 726 potential donors, 374 potential donors (51.5%) finally reached donation; 352 potential donors (48.5%) were excluded for various reasons. Donor reasons were 29.8%, including medical problems, withdrawal of consent, graft volume issues, and identification of a better suitable donor. Recipient reasons were 20.7%, including recipient death or recovery, allocation to deceased donor, and progressions of hepatocellular carcinoma. A total of 38 (5.2%) potential donors had a fatty liver. Among them, 15 (39.5%) potential donors tried short-term weight reduction and eventually were able to donate. In conclusion, the main reasons for donor exclusion were medical problems and withdrawal of consent. Therefore, thorough medical screening and careful examination for donor voluntarism are important in the donor evaluation process. Liver Transplantation 23 614-624 2017 AASLD.

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Living Donor Liver Transplantation: Usefulness of Hemostatic and Prothrombotic Screening in Potential Donors

Cited by 17 publications

References 19 publications

Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients

Anesthesia and outcome after partial hepatectomy for adult-to-adult donor transplantation

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

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