D. J. Cha1, E. J. Alfrey3,4, D. M. Desai1,2, C. S. Hwang1,2 1University Of Texas Southwestern Medical Center,Division Of Surgical Transplantation/Department Of Surgery,Dallas, TX, USA 2Children’s Medical Center,Division Of Pediatric Transplantation,Dallas, Tx, USA 3Marin General Hospital,Department Of General Surgery,Larkspur, CA, USA 4Prima Medical Group,Larkspur, CA, USA
Introduction:
Pediatric patients who undergo liver transplantation are at higher risk of developing vascular complications when compared to adult liver transplant recipients. The consequences of hepatic artery thrombosis (HAT) or portal vein thrombosis (PVT) can cause significant morbidity and mortality. We examined pediatric liver transplant recipients who developed vascular thrombosis, either HAT or PVT, and the presence of thrombophilia.
Methods:
We examined outcome in all pediatric patients who underwent liver transplantation between January 2010 and July 2014. Recipient and donor demographic data and outcome data were examined. Demographic and outcome data included age, race, sex, weight, blood type, cold storage time (CST, time from donor aortic cross clamp to out of ice) in minutes, anastomotic time in minutes, estimated blood loss (EBL) at transplant, intraoperative transfusion requirement, presence and number of rejections, graft survival, mode of arterial anastomosis (artery to artery vs. conduit), HAT, PVT, and presence of thrombophilia. Categorical differences were compared using the unpaired Student's t-test and nominal variables using either the Chi Square or the Fischer's exact test. A p-value of <0.05 was considered significant.
Results:
Forty-six pediatric patients underwent liver transplantation. The mean recipient age in months at transplantation was 62.7+/-59.5 months, mean weight was 20.2+/-15.5 kg, mean CST was 432+/-98 minutes, mean anastomotic time was 57+/-17 minutes, mean EBL was 399+/-501 mL, mean intraoperative transfusion requirement was 360+/-371 mL, mean donor age was 89.5+/-115 months, and mean donor weight was 26.3+/-20.7 kg. Twenty-one recipients were found to have thrombophilia, including 5 with HAT and 2 with PVT.
When comparing recipients with or without any vascular thrombosis, those with thrombophilia had a significantly higher incidence of developing a vascular thrombosis (7/21 vs. 0/25, P = 0.0017). Five of 42 recipients with artery to artery reconstruction developed HAT versus 0 of 4 with a conduit. Recipients who developed any thrombosis were significantly lower in weight than those who did not develop any thrombosis (9.0+/-1.6 kg vs. 22.2+/-16.0 kg, P = 0.0366), Table.
Conclusion:
All pediatric liver transplant recipients who developed any vascular thrombosis were also found to have thrombophilia. Recipients who were smaller in size were at significantly higher risk of developing vascular thrombosis. Lower weight recipients with thrombophilia may benefit from arterial reconstruction with a conduit to decrease the risk of vascular thrombosis.
