Reeder Francesca, Griffin Jessica, Carter Matthew, Lowing Holly, Babu Praharsh, Quarrell Andrew, Moore Tracy, Foukaneli Theodora, Besser Martin, Amin Irum, Woodward Jeremy, Russell Neil, Massey Dunecan, Gaurav Rohit, Sharkey Lisa, Rutter Charlotte, Butler Andrew, Thomas Will
Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom.
Res Pract Thromb Haemost. 2025 Jul 30;9(5):102990. doi: 10.1016/j.rpth.2025.102990. eCollection 2025 Jul.
Cambridge University Hospitals NHS Foundation Trust provides an adult intestinal/multivisceral transplant service to the United Kingdom. These patients can have complex thrombotic histories and are at risk of bleeding and thrombosis posttransplant.
We describe our experience of (a) bleeding and thrombosis posttransplant, (b) transplantation for acute abdominal vascular catastrophe, and (c) use of direct oral anticoagulants (DOACs) posttransplant.
A retrospective study of recipients of intestinal transplants at our center between 2007 and June 2023 was conducted.
Of 138 recipients (who received 145 grafts), 96 (70%) had a history of thrombosis pretransplant. Of the 145 grafts, 138 (95%) received blood products in the immediate operative period (up to 24 hours postoperatively; day +1) and 6 of 145 (4%) had an intraoperative thrombosis. Major bleeding and thrombosis rates from day +2 to +92 posttransplant were 38.0% (95% CI, 30.0%-46.0%) and 26.1% (95% CI, 19.1%-33.5%), respectively. Bleeds were predominantly gastrointestinal, surgical site, or intra-abdominal. The majority of thromboses (32 of 38 [84%]) were venous (especially catheter associated). No particular relationship between thrombotic and bleeding complications was observed. Eight recipients were transplanted as salvage procedures due to abdominal vascular catastrophe with generally favorable results, although in 3 recipients, no etiology was identified, and anticoagulant failures were seen. Five received DOACs posttransplant, and adequate peak drug levels were seen without bleeding or thrombotic complications.
Patients who undergo intestinal transplant are at high risk of bleeding and thrombosis posttransplant. Intestinal transplant was used successfully as a salvage treatment for acute abdominal vascular catastrophe. DOACs were used in selected posttransplant patients. Further multicenter studies are required.
剑桥大学医院国民保健服务基金会信托为英国提供成人肠道/多脏器移植服务。这些患者可能有复杂的血栓形成病史，移植后有出血和血栓形成的风险。
我们描述了我们在（a）移植后出血和血栓形成、（b）急性腹部血管灾难的移植以及（c）移植后直接口服抗凝剂（DOACs）使用方面的经验。
对2007年至2023年6月期间我们中心肠道移植受者进行了一项回顾性研究。
在138名受者（接受了145次移植）中，96名（70%）移植前有血栓形成病史。在145次移植中，138次（95%）在手术即刻期（术后24小时内；第+1天）接受了血液制品，145次中有6次（4%）发生术中血栓形成。移植后第+2天至+92天的大出血和血栓形成率分别为38.0%（95%CI，30.0%-46.0%）和26.1%（95%CI，19.1%-33.5%）。出血主要发生在胃肠道、手术部位或腹腔内。大多数血栓形成（38次中的32次[84%]）为静脉血栓（尤其是与导管相关的）。未观察到血栓形成和出血并发症之间有特定关系。8名受者因腹部血管灾难作为挽救性手术进行了移植，总体结果良好，尽管在3名受者中未确定病因，且出现了抗凝失败。5名受者移植后接受了DOACs治疗，观察到药物峰值水平充足，无出血或血栓形成并发症。
接受肠道移植的患者移植后有出血和血栓形成的高风险。肠道移植成功用作急性腹部血管灾难的挽救性治疗。DOACs用于部分移植后患者。需要进一步的多中心研究。
