Pulmonary thromboembolism during adult liver transplantation: incidence, clinical presentation, outcome, risk factors, and diagnostic predictors

Abstract

These findings confirmed clinical significance of PTE during adult LT and suggested the possibility of predicting this devastating complication.

Low Incidence of Hyperfibrinolysis and Thromboembolism in 195 Primary Liver Transplantations Transfused with Solvent/Detergent-Treated Plasma

“…This compares favorably to results with FFP. 9 Thus, our data support our clinical experience with Octaplas being safe with regard to occurrence of thromboembolic complications. Also, 1-2 g tranexamic acid administered because of hyperfibrinolysis does not seem to be associated with increased numbers of thromboembolic events in our study of liver transplants.…”

“…Patients with intraoperatively detected hyperfibrinolysis received significantly increased numbers of RBC, plasma, and platelet units. This was the case not only in the perioperative period as shown in Figure 2, but also in the period later than 24 hours after start of surgery, when significantly more RBC (median [IQR] 3.5 [2][3][4][5][6][7][8][9] were transfused. No differences were found before the perioperative period (data not shown).…”

“…International Normalized Ratio (INR) values higher than 2.0 were in most cases corrected with plasma or, in cases of severe coagulopathy and/or volume overload, with prothrombin complex (factors II, VII, IX, and X, as well as proteins C and S) from various manufacturers. Platelets were most often transfused if the preoperative count was below 30-40 x10 9 /L, and the patient had a bleeding tendency assessed clinically and/or by thromboelastography (TEG). We did not routinely administer any antifibrinolytic agent.…”

“…One disadvantage of SD-plasma is that the SD-process inevitably reduces the levels of α2-antiplasmin and protein S, and could increase the risk of hyperfibrinolysis 8 or thromboembolic events such as pulmonary embolism during liver transplantation. 9 In addition to the track record of SD-plasma in Europe during the last two decades, both randomized controlled trials [10][11][12] and critical reviews 4,6 have suggested that these risks are largely theoretical. US SD-plasma was first introduced in 1998, but production was terminated in [2002][2003] in part due to thromboembolic complications not observed with European SD-plasma.…”

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“…9,16 The incidence of pulmonary embolism is reported to be 0.3% to 4% overall in the literature in liver transplant patients. [22][23][24] Although no patients had documented pulmonary embolism or pneumothorax at the first visit in our study group, respiratory failure at the second visit was suggested to be caused by pulmonary embolism and pneumothorax in 3 patients. Therefore, we suggest that clinicians should be more aware of the presence of respiratory failure during the early postoperative period (between 1 and 4 weeks after transplant) than during the immediateearly postoperative period (within the first week) in liver transplant recipients.…”