Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Pediatr Blood Cancer. 2022 Oct;69(10):e29898. doi: 10.1002/pbc.29898. Epub 2022 Jul 29.
Systemic anticoagulation after pediatric liver transplantation (pLT) is believed to reduce the incidence of vascular thrombosis, but it may also cause an increase in hemorrhagic complications.
A 5-year retrospective review of pLT done at our institution was performed (2014-2018). The occurrence of early hemorrhagic and thrombotic complications was compared when using low-dose or high-dose anticoagulation after transplant (p < .05 considered significant).
Sixty-nine patients received 73 transplants during the study period. Median age at transplant was 2.3 years (40 days to 18.5 years). Low-dose anticoagulation was utilized in 71% cases. Additionally, six patients were converted from low-dose to high-dose anticoagulation because of a thrombotic event or concerns for suboptimal vascular inflow. Postoperative anticoagulation was discontinued in 18 occurrences due to bleeding (low dose 19%, high dose 47% vs. low dose to high dose 17%, p = .085). Surgical take back for bleeding occurred in 17 occasions (low dose 13.5%, high dose 53% vs. low dose to high dose 33%, p = .005). The overall incidence of hepatic artery thrombosis (HAT) and portal vein thrombosis were each 5.5%, respectively. While patient survival was not statistically different between groups, graft survival was significantly lower in the high-dose group (low dose 93%, high dose 73% vs. low dose to high dose 100%, p = .046). However, graft losses from HAT were similar between groups (low dose 2%, high dose 7% vs. low dose to high dose 0%, p = .56).
The use of a standardized risk-adjusted anticoagulation protocol after pLT is associated with a low occurrence of thrombotic and hemorrhagic complications. High-dose anticoagulation leads to more bleeding, but those risks outweigh the risks of possible graft loss.
在小儿肝移植（pLT）后进行全身抗凝被认为可以降低血管血栓形成的发生率，但也可能导致出血并发症增加。
对我院进行的 5 年回顾性 pLT 研究（2014-2018 年）。比较了移植后使用低剂量或高剂量抗凝时早期出血和血栓形成并发症的发生情况（p<0.05 认为有统计学意义）。
69 例患者在研究期间接受了 73 次移植。移植时的中位年龄为 2.3 岁（40 天至 18.5 岁）。71%的病例采用低剂量抗凝。此外，由于血栓形成事件或对血管流入不足的担忧，有 6 例患者从低剂量转为高剂量抗凝。由于出血（低剂量 19%，高剂量 47%与低剂量转为高剂量 17%，p=0.085），18 例患者停止术后抗凝。因出血而进行手术取栓 17 次（低剂量 13.5%，高剂量 53%与低剂量转为高剂量 33%，p=0.005）。肝动脉血栓形成（HAT）和门静脉血栓形成的总发生率分别为 5.5%。虽然各组患者生存率无统计学差异，但高剂量组移植物生存率显著较低（低剂量 93%，高剂量 73%与低剂量转为高剂量 100%，p=0.046）。然而，HAT 导致的移植物丢失在各组间相似（低剂量 2%，高剂量 7%与低剂量转为高剂量 0%，p=0.56）。
在 pLT 后使用标准化风险调整抗凝方案与血栓形成和出血并发症的低发生率相关。高剂量抗凝会导致更多出血，但这些风险超过了可能的移植物丢失风险。
