Balaceanu Alice
Internal Medicine Department, "Sf. Ioan" Clinical Emergency Hospital, "Carol Davila" University of Medicine and Pharmacy, Sos. Vitan-Bârzești nr. 13, Bucharest, Romania.
Ir J Med Sci. 2019 Nov;188(4):1191-1193. doi: 10.1007/s11845-019-01998-6. Epub 2019 Mar 8.
In the European Liver Transplant Registry, there are 137,863 liver transplantations recorded. Forty-one percent of patients survived 20 years after liver transplantation in the European countries. From 1988, when the US database for liver transplantation was created, to 2006, there are more than 56,000 liver transplants. Almost 80% of the liver transplant recipients survived 5 years after transplantation. The incidence of deep vein thrombosis (DVT) in the European population is 70-140/100.000 person-years. Cancer, paresis, immobilization, thrombophilia, inflammatory bowel disease, replacement hormonal or contraceptive therapies are associated with an increased risk of occurrence DVT or complications. The incidence of DVT in long-term surveillance of liver transplant recipients is unknown. Immunosuppressive therapy, thrombophilia abnormalities, hepatitis C and hepatocellular carcinoma recurrence, renal insufficiency, malignant tumours, obesity and diabetes were associated with DVT in long-term post-liver transplantation. The reported maximum time between liver transplantation and DVT was 210 days.
The aim of the study is to update existing data in the literature regarding the occurrence and management of deep vein thrombosis in liver transplant patients over the long-term surveillence period.
There are no specific guideline recommendations regarding acute DVT treatment in long-term surveillance after liver transplantation. Low molecular weight heparin (LMWH), unfractionated heparin (UFH) and vitamin K antagonist (VKA) are the anticoagulants used in specific complications post-transplantation. The safety and the efficacy of direct anticoagulants in liver transplantation recipients need to be assessed in future trials. Given that long-term survival of liver transplantation is much improved, complications associated with transplantation and ageing require appropriate cardiovascular guidelines.
欧洲肝脏移植登记处记录了137,863例肝脏移植手术。在欧洲国家，41%的患者在肝移植后存活了20年。从1988年美国建立肝脏移植数据库到2006年，有超过56,000例肝脏移植手术。近80%的肝移植受者在移植后存活了5年。欧洲人群中深静脉血栓形成（DVT）的发病率为70 - 140/100,000人年。癌症、麻痹、制动、血栓形成倾向、炎症性肠病、替代激素或避孕疗法与DVT发生或并发症风险增加有关。肝移植受者长期监测中DVT的发病率尚不清楚。免疫抑制治疗、血栓形成倾向异常、丙型肝炎和肝细胞癌复发、肾功能不全、恶性肿瘤、肥胖和糖尿病与肝移植术后长期DVT有关。报道的肝移植与DVT之间的最长时间为210天。
本研究的目的是更新文献中关于肝移植患者在长期监测期内深静脉血栓形成的发生和管理的现有数据。
对于肝移植后长期监测中的急性DVT治疗，尚无具体的指南建议。低分子量肝素（LMWH）、普通肝素（UFH）和维生素K拮抗剂（VKA）是移植后特定并发症中使用的抗凝剂。直接抗凝剂在肝移植受者中的安全性和有效性需要在未来的试验中进行评估。鉴于肝移植的长期生存率有了很大提高，与移植和衰老相关的并发症需要适当的心血管指南。
