Ziaziaris William A, Darani Alexandre, Holland Andrew J A, Alexander Angus, Karpelowsky Jonathan, Barbaro Pasquale, Stormon Michael, O'Loughlin Edward, Shun Albert, Thomas Gordon
Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Pediatr Transplant. 2017 Jun;21(4). doi: 10.1111/petr.12917. Epub 2017 Mar 22.
We aimed to assess the incidence of HAT over three eras following implementation of microvascular techniques and a customized anticoagulation protocol in a predominantly cadaveric split liver transplant program. We retrospectively reviewed pediatric liver transplants performed between April 1986 and 2016 and analyzed the incidence HAT over three eras. In E1, 1986-2008, each patient received a standard dose of 5 U/kg/h of heparin and coagulation profiles normalized passively. In E2, 2008-2012, microvascular techniques were introduced. In E3, 2012-2016, in addition, a customized anticoagulation protocol was introduced which included replacement of antithrombin 3, protein C and S, and early heparinization. A total of 317 liver transplants were completed during the study period, with a median age of 31.7 months. In E1, 22% of grafts were cadaveric in situ split grafts, while the second and third eras used split grafts in 59.0% and 64.9% of cases, respectively. HAT occurred in 9.5% in the first era, 11.5% (P=.661) in the second, and dropped to 1.8% in the third era (P=.043). A routine anticoagulation protocol has significantly reduced the incidence of HAT post-liver transplantation in children in a predominantly cadaveric in situ split liver transplant program.
我们旨在评估在一个主要采用尸体供肝劈离式肝移植的项目中，在实施微血管技术和定制抗凝方案后的三个时期内肝动脉血栓形成（HAT）的发生率。我们回顾性分析了1986年4月至2016年间进行的小儿肝移植病例，并分析了三个时期内HAT的发生率。在E1期（1986 - 2008年），每位患者接受5 U/kg/h的标准剂量肝素，凝血指标被动恢复正常。在E2期（2008 - 2012年），引入了微血管技术。在E3期（2012 - 2016年），此外还引入了定制抗凝方案，包括补充抗凝血酶3、蛋白C和S，并早期肝素化。研究期间共完成317例肝移植，中位年龄为31.7个月。在E1期，22%的移植物为尸体原位劈离式移植物，而在第二和第三时期，分别有59.0%和64.9%的病例使用劈离式移植物。HAT在第一时期的发生率为9.5%，第二时期为11.5%（P = 0.661），在第三时期降至1.8%（P = 0.043）。在一个主要采用尸体原位劈离式肝移植的项目中，常规抗凝方案显著降低了儿童肝移植术后HAT的发生率。
