Venous Thrombotic Events After Liver Transplantation

Abstract

Thromboprophylaxis is not well defined after liver transplantation (LT). The aim of this study was to evaluate the incidence of splanchnic vein thrombosis (SVT) and nonsplanchnic vein thrombosis (NSVT) after LT. Liver transplantations performed between 2009 and 2013 in our institution were reviewed. Demographic, intraoperative, and postoperative data were recorded. Low-molecular-weight heparin was only administered postoperatively if intraoperative thrombectomy was performed or in patients preoperatively anticoagulated. Of a total of 328 patients, 72% were male with a median age of 56 years, score of model for end-stage liver disease 18 (11-23), and 88% had liver cirrhosis. The incidence of postoperative venous thrombotic events was 4.6%: 8 (2.4%) patients had SVT and 7 (2.1%) patients had NSVT. After logistic regression analysis, intraoperative thrombectomy and Child A classification emerged as risk factors for SVT (odds ratio [OR]: 77, 95% confidence interval [95% CI]: 14-421) and NSVT (OR: 20, 95% CI: 3-170), respectively. The incidence of SVT in patients who undergo intraoperative thrombectomy was 33%, whereas the incidence of NSVT in patients grouped as Child A was 7.5%. Our results suggest that thromboprophylaxis should be considered after LT in patients with cirrhosis grouped as Child A and in patients who undergo intraoperative thrombectomy.

Is antivitamin K reversal required in patients with cirrhosis undergoing liver transplantation?

“…We found that patients with incidental PVT had more thromboses in the liver graft early after surgery. A higher incidence of postoperative PVT in patients with previous PVT was reported by our group 28 and corroborated by others more recently 29 …”

Incidence of Bleeding and Thrombosis in Patients with Liver Disease

“…The incidence of splanchnic vein thrombosis (SVT) was 2.4% with a further 2.1% diagnosed with nonsplanchnic VTE (upper/lower limb DVT or PE). 69 Of note, intraoperative thrombectomy was strongly associated with postoperative SVT as highlighted in ►Fig.…”

“…Occurrence of splanchnic vein thrombosis (SVT) postliver transplantation (LT). Adapted from Blasi et al69 . All pretransplant SVT involved the portal vein.…”

Hemostatic Complications in Hepatobiliary Surgery

“…These reports showed incidences varying between 4.5 and 8.6%. [80][81][82][83][84] Notably, the study that reported an incidence of 8.6% only considered the number of deep vein thrombosis, 82 an even higher incidence would likely have been found if pulmonary embolisms had been taken into account. Importantly, none of the patients in this study received pharmacological thromboprophylaxis.…”

“…84 In two other cohorts assessing incidence of VTE following liver transplantation, numbers on the use of prophylaxis were absent or only given when patients received anticoagulant treatment before surgery or when an intraoperative thrombectomy was performed. 80,81 Pharmacological thromboprophylaxis may also help to prevent early PVT or HAT, but to our knowledge, the effect of routine thromboprophylaxis on PVT or HAT has never been assessed in the postliver transplant population. Thromboprophylaxis has been shown to reduce the risk for PVT following partial hepatectomy, 106 suggesting a role for anticoagulation in post-transplant hepatic vessel thrombosis.…”