Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Thromb Haemost. 2020 Apr;120(4):627-637. doi: 10.1055/s-0039-1701010. Epub 2020 Jan 29.
Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) are serious causes of morbidity and mortality after pediatric liver transplantation. To reduce thrombotic complications, routine antithrombotic therapy consisting of 1 week heparin followed by 3 months acetylsalicylic acid, was implemented in our pediatric liver transplant program in 2003. This study aimed to evaluate incidences of bleeding and thrombotic complications since the implementation of routine antithrombotic therapy and to identify risk factors for these complications.
This retrospective cohort study includes 200 consecutive pediatric primary liver transplantations performed between 2003 and 2016. Uni- and multivariate logistic regression analysis, Kaplan-Meier method, and Cox regression analysis were used to evaluate recipient outcome.
HAT occurred in 15 (7.5%), PVT in 4 (2.0%), and venous outflow tract thrombosis in 2 (1.0%) recipients. Intraoperative vascular interventions (odds ratio [OR] 14.45 [95% confidence interval [CI] 3.75-55.67]), low recipient age (OR 0.81 [0.69-0.95]), and donor age (OR 0.96 [0.93-0.99]) were associated with posttransplant thrombosis. Clinically relevant bleeding occurred in 37%. Risk factors were high recipient age (OR 1.08 [1.02-1.15]), high Child-Pugh scores (OR 1.14 [1.02-1.28]), and intraoperative blood loss in mL/kg (OR 1.003 [1.001-1.006]). Both posttransplant thrombotic (hazard ratio [HR] 3.38 [1.36-8.45]; = 0.009) and bleeding complications (HR 2.50 [1.19-5.24]; = 0.015) significantly increased mortality.
In 200 consecutive pediatric liver transplant recipients receiving routine postoperative antithrombotic therapy, we report low incidences of posttransplant vascular complications. Posttransplant antithrombotic therapy seems to be a valuable strategy in pediatric liver transplantation. Identified risk factors for bleeding and thrombotic complications might facilitate a more personalized approach in antithrombotic therapy.
肝动脉血栓形成（HAT）和门静脉血栓形成（PVT）是小儿肝移植后发病率和死亡率的严重原因。为了减少血栓并发症，自 2003 年以来，我们的小儿肝移植项目采用了包括 1 周肝素和 3 个月乙酰水杨酸的常规抗血栓治疗。本研究旨在评估实施常规抗血栓治疗后出血和血栓并发症的发生率，并确定这些并发症的危险因素。
这是一项回顾性队列研究，包括 2003 年至 2016 年期间进行的 200 例连续小儿原发性肝移植。采用单变量和多变量逻辑回归分析、Kaplan-Meier 方法和 Cox 回归分析评估受者结局。
15 例（7.5%）发生 HAT，4 例（2.0%）发生 PVT，2 例（1.0%）发生静脉流出道血栓形成。术中血管介入（比值比 [OR] 14.45 [95%置信区间 [CI] 3.75-55.67]）、受体年龄较低（OR 0.81 [0.69-0.95]）和供体年龄（OR 0.96 [0.93-0.99]）与移植后血栓形成相关。发生临床相关出血 37%。危险因素为受体年龄较高（OR 1.08 [1.02-1.15]）、Child-Pugh 评分较高（OR 1.14 [1.02-1.28]）和术中失血量（OR 1.003 [1.001-1.006]）。移植后血栓形成（危险比 [HR] 3.38 [1.36-8.45]；=0.009）和出血并发症（HR 2.50 [1.19-5.24]；=0.015）显著增加死亡率。
在 200 例连续接受常规术后抗血栓治疗的小儿肝移植受者中，我们报告了移植后血管并发症的发生率较低。移植后抗血栓治疗似乎是小儿肝移植的一种有价值的策略。出血和血栓形成并发症的确定危险因素可能有助于在抗血栓治疗中采用更个性化的方法。
