Pediatric Surgery Unit, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, Paris 75015, France.
Pediatric Hepatology Unit, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, Paris 75015, France.
J Pediatr Surg. 2022 Nov;57(11):666-675. doi: 10.1016/j.jpedsurg.2022.06.008. Epub 2022 Jul 2.
After liver transplantation (LT), synthesis of coagulation factors by the graft recovers faster for pro thrombotic than anti thrombotic factors, resulting in a potential pro thrombotic imbalance. We studied the thrombotic and hemorrhagic complications in our pediatric LT series, providing supplementation of fresh frozen plasma (FFP) and/or antithrombin (AT) in the prophylactic antithrombotic regimen.
This was a retrospective observational single center study. All isolated pediatric LTs performed between 1/11/2009 and 31/12/2019 (n = 181) were included. Postoperatively, in addition to low molecular weight heparin, 22 patients (12%) received FFP (10 ml/kg twice daily for 10 days), 27 patients (15%) were given FFP (reduced duration) and AT (50-100 IU/kg/day if AT activity remained <70%), and 132 (73%) received AT only. Complications, outcome, and coagulation profiles in postoperative days 0-10 were analyzed.
In all three treatment groups, AT activity normalized by day 4 while prothrombin remained <70% of normal until day 9. Hepatic artery thrombosis (HAT), portal vein thrombosis (PVT), and hemorrhagic complications occurred in 2.8%, 3.3%, and 3.9% of LTs. One- and 5-year patient and graft survival were 88% (±2.4% Standard Error) and 84% (±2.5%), and 86% (±2.6%) and 84% (±2.7%), respectively, without difference between groups. HAT were associated with low AT on days 0 and 1, and PVT with low AT on day 0.
Low antithrombin activity after LT was associated with postoperative thromboses. FFP and/or AT supplementation allowed early normalization of AT activity, while thrombotic or hemorrhagic complications were rare, suggesting efficient and safe management of post-LT coagulopathy.
肝移植（LT）后，移植物合成凝血因子的速度对于促血栓形成因子比抗血栓形成因子更快，导致潜在的促血栓形成失衡。我们研究了我们的儿科 LT 系列中的血栓形成和出血并发症，在预防性抗血栓形成方案中提供新鲜冷冻血浆（FFP）和/或抗凝血酶（AT）的补充。
这是一项回顾性观察性单中心研究。纳入 2009 年 11 月 1 日至 2019 年 12 月 31 日期间进行的所有孤立性儿科 LT（n=181）。术后，除低分子肝素外，22 例患者（12%）接受 FFP（10ml/kg，每日 2 次，共 10 天），27 例患者（15%）接受 FFP（缩短疗程）和 AT（如果 AT 活性仍<70%，则给予 50-100IU/kg/天），132 例患者（73%）仅接受 AT。分析术后 0-10 天的并发症、结局和凝血谱。
在所有三组治疗中，AT 活性在第 4 天恢复正常，而凝血酶原在第 9 天仍<70%正常。肝动脉血栓形成（HAT）、门静脉血栓形成（PVT）和出血并发症分别发生在 2.8%、3.3%和 3.9%的 LT 中。1 年和 5 年患者和移植物存活率分别为 88%（±2.4%标准误差）和 84%（±2.5%），和 86%（±2.6%）和 84%（±2.7%），各组之间无差异。HAT 与术后第 0 天和第 1 天 AT 活性低有关，而 PVT 与第 0 天 AT 活性低有关。
LT 后低抗凝血酶活性与术后血栓形成有关。FFP 和/或 AT 补充可使 AT 活性早期恢复正常，且血栓形成或出血并发症罕见，表明 LT 后凝血功能障碍的管理有效且安全。
